磁共振管壁成像观察他汀类药物对老年人胸主动脉粥样硬化斑块特征的影响

Influences of statin treatment on MR vessel wall imaging-observed characteristics of atherosclerotic plaque in the thoracic aorta in the elderly

目的应用磁共振管壁成像技术评价他汀类药物对老年人胸主动脉粥样硬化斑块成分及负荷特征的影响。方法前瞻性研究，该研究的人组人群为60岁以上，且无任何严重心脑血管症状的老年人。所有受试者均进行胸主动脉磁共振管壁扫描。图像判读人员将定量测量胸主动脉粥样硬化斑块的负荷，定性分析斑块的成分，并评价他汀类药物对这些特征的影响。将胸主动脉分为3段，即升主动脉段，主动脉弓段以及降主动脉段。结果55例受试者存在胸主动脉粥样硬化斑块，其中使用他汀组24例，平均年龄（73．8±6．3）岁，12例（50．0％）为男性。使用他汀组的低密度脂蛋白及总胆固醇水平均低于未使用他汀组，分别为（2．4±0．7）mmol／L比（3．1±0．8）mmol／L（P〈0．01）、（4．4±0．6）mmol／L比（5．1±1．0）mmol／L（P〈0．01）。使用他汀组胸主动脉各段的管腔面积、管壁面积以及血管总面积均小于未使用他汀组，差异有统计学意义（均P〈0．05）。使用他汀组主动脉弓段和降主动脉段的平均管壁厚度均小于未使用他汀组，分别为（2．7±0．3）mm比（2．8±0．4）mm（P〈0．01）、（2．5±0．4）mm比（2．6±0．5）mm（P〈0．01）。另外，使用他汀组斑块内出血／血栓的发生率低于未使用他汀组，分别为6例（25．0％）比8例（25．8％），差异无统计学意义（P〉0．05）。结论他汀类药物不仅可以降低血脂水平，还可减小老年人胸主动脉粥样硬化斑块的负荷，维持斑块的稳定。

Objective To evaluate the influences of statin treatment on MR vessel wall imagingobserved characteristics of atherosclerotic plaque in the thoracic aorta of the elderly. Methods Elderly subjects （≥60 years ） without any serious cerebro-cardiovascular diseases were recruited. Thoracic aorta was imaged on MR scanner for all the subjects. The plaque burden was calculated quantitatively, the composition of plaque in thoracic aorta was evaluated qualitatively, and the contributions of statin treatment to these characteristics were also compared by image interpretation personals. The thoracic aorta was divided into three segments （AAO： ascending aorta; AOA： aortic arch,and DOA： descending aorta）on the imaging. Results Totally 55 recruited subjects had atherosclerotic plaque in thoracic aorta, with 24 subjects receiving statin treatment, and 50 % （12/24） male,aged 73.8±6.3 years. The level of LDL-C[（2. 4±0. 7） mmol/L vs. （3.1±0.8） mmol/L（P〈0.01）]and total cholesterol[（4.4±0.6）mmol/L vs. （5.1±1.0）mmol/L（P〈0.01）]were significantly lower in statin group than in non-statin group. The lumen area, wall area, and total vessel area in all three segments of thoracic aorta were significantly smaller in statin group（all P〈0.05）than in non- statin group. The average wall thickness in segment of AOA]（2.7±0.3）mm vs. （2.8±0.4）mm（P〈 0.01）]and DAO（（2.5±0.4）mm vs. （2.6±0.5）mm（P〈0.01）]were smaller in statin group than in non-statin group. The incidence rate of intraplaque hemorrhage / mural thrombus [6 cases （25.0%） vs. 8 cases（25.8%）]in thoracic aorta was a little lower in statin group than in non-statin group, with no significant difference（P〉0.05）. Conclusions Statin treatment decreases LDL-C level, reduces the burden of atherosclerotic plaque in thoracic aorta, and maintains the atherosclerotic plaque stability.