高脂血症与颈动脉粥样硬化斑块的关系研究

Relationship Between Hyperlipidemia and Carotid Atherosclerotic Plaque

目的探讨高脂血症与颈动脉粥样硬化斑块特征的关系。方法回顾性分析2011年5月-2015年12月中国动脉粥样硬化风险评估(CARE-Ⅱ)中584例因急性缺血性脑卒中或短暂性脑缺血发作行颈动脉高分辨MRI血管壁成像患者,测量并计算颈动脉平均管腔面积、平均管壁面积、平均管壁体积、平均标准化管壁指数、最大管壁厚度、平均管壁厚度,识别及测量脂质坏死核心、钙化、斑块内出血、纤维帽破裂、斑块表面溃疡,鉴定高危斑块,将患者分为高脂血症组和非高脂血症组,比较两组症状侧颈动脉粥样硬化斑块特征和临床特征,评估高脂血症与颈动脉斑块特征的相关性,分析颈动脉粥样硬化斑块特征与血脂成分的相关性。结果584例患者高脂血症组351例(60.10%),非高脂血症组233例(39.90%);两组平均管腔面积、最大管壁厚度、平均管壁厚度、平均标准化管壁指数、脂质坏死核心及斑块内出血发生率、脂质坏死核心体积百分比比较,差异有统计学意义(P<0.05);Logistic回归分析显示,高脂血症与平均管腔面积、脂质坏死核心相关,与颈动脉斑块负荷、脂质坏死核心体积不相关;高水平总胆固醇与平均管腔面积负相关,与最大管壁厚度正相关,与斑块内出血的存在及AHAⅥ型斑块存在相关,高水平低密度脂蛋白胆固醇、高水平甘油三酯及低水平高密度脂蛋白胆固醇与颈动脉斑块特征均不相关。结论高脂血症患者颈动脉粥样硬化更严重,未来缺血性卒中风险更高,尤其是高水平总胆固醇患者有更大几率出现高风险斑块,在临床管理中应重视。

Objective To investigate the relationship between hyperlipidemia and carotid atherosclerotic plaque characteristics.Methods A total of584 patients with carotid artery high-resolution MRI angiography due to acute ischemic stroke or transient ischemic attack from May 2011 to December 2015 in the Chinese Atherosclerosis Risk Evaluation(CARE-Ⅱ)were retrospectively analyzed.The average lumen area,average wall area,average wall volume,average standardized wall index,maximum wall thickness,and average wall thickness of the carotid artery were measured and calculated.The lipid necrosis core,calcification,intra-plaque hemorrhage,fibrous cap rupture,and plaque surface ulcer were identified and measured.The patients were divided into hyperlipidemia group and non-hyperlipidemia group.The characteristics and clinical features of symptomatic carotid atherosclerotic plaque were compared between the two groups.The correlation between hyperlipidemia and carotid plaque characteristics was evaluated,and the correlation between carotid atherosclerotic plaque characteristics and blood lipid components was analyzed.Results There were 584patients,351 patients(60.10%)in the hyperlipidemia group and 233 patients(39.90%)in the non-hyperlipidemia group.There were statistically significant differences in the average lumen area,the maximum wall thickness,the average wall thickness,the average standardized wall index,the incidence of lipid necrosis core and intraplaque hemorrhage,and the percentage of lipid necrosis core volume between the two groups(P<0.05).Logistic regression showed that hyperlipidemia was correlated with the average lumen area and lipid necrosis core,but not with carotid plaque load and lipid necrosis core volume.High level of total cholesterol was negatively correlated with mean lumen area,positively correlated with maximum wall thickness,and correlated with the presence of intraplaque hemorrhage and AHAⅥplaque.High level of low density lipoprotein cholesterol,high level of triglyceride and low level of high density lipoprotein cholesterol were not correlated with carotid plaque characteristics.Conclusion Patients with hyperlipidemia have more severe carotid atherosclerosis and higher risk of ischemic stroke in the future,especially patients with high level of total cholesterol have a greater chance of developing high-risk plaques,which should be paid more attention in clinical management.