颈动脉CT血管成像评估他汀类药物治疗前后颈动脉斑块进展的研究

Evaluation of carotid plaque progression before and after statin therapy by carotid CT angiography

目的:通过颈动脉CT血管成像定量评价颈动脉粥样硬化斑块及管腔形态学特征,探讨他汀类药物对颈动脉粥样斑块的作用。方法:回顾性入选2022年4月至2023年4月,在北京市顺义区医院放射科进行CTA复查且有基线检查的颈动脉粥样硬化患者140例,根据是否应用他汀类药物治疗分为应用组和未用组,测量两组患者颈动脉的狭窄率、斑块易损性、斑块负荷和斑块体积等影像形态学特征,计算复查前后年化变化率。结果:两组患者颈动脉狭窄及斑块均有不同程度进展,但未应用他汀组狭窄率年变化率、斑块负荷年变化率、管壁/管腔比年变化率更高(P均<0.05)。复查时高危易损斑块出现比例更高(P=0.009),其中斑块内低密度出现的比例较高(P=0.020)。应用他汀组钙化斑块负荷年变化率增长更高(P=0.003)。结论:他汀类药物对颈动脉粥样硬化斑块进展具有一定抑制作用,包括延缓斑块负荷的增加、延缓动脉管腔狭窄的加重;同时对颈动脉斑块具有一定稳定作用,包括减少易损斑块出现以及促进斑块钙化。

Objective:Quantitative evaluation of carotid atherosclerotic plaque and lumen morphological characteristics by carotid CT angiography,and to explore the effect of statins on carotid atherosclerotic plaque.Methods:A total of 140 patients with carotid atherosclerosis were retrospectively enrolled.All the patients underwent CTA reexamination from April 2022 to April 2023 in the radiology department of Shunyi District Hospital of Beijing and had baseline examination.According to whether statins were used or not,they were divided into two groups.The imaging morphological characteristics such as stenosis rate,plaque vulnerability,plaque burden and plaque volume of each carotid artery in the two groups were measured,and the annual change rate was calculated.The count data were tested by x2 test,the difference between the two groups of normal distribution measurement data was tested by t test,the difference between the two groups of non-normal distribution measurement data was tested by U test.Results:Carotid artery stenosis and plaque in both groups had different degrees of progress.However,the annual change rate of stenosis rate,annual change rate of plaque load and annual change rate of wall/lumen ratio were higher in the naive-statin group(all P<0.05).The proportion of high-risk vulnerable plaques(P=0.009),and low-density plaques(P=0.020)in the naive-statin group was higher.The annual change rate of calcified plaque burden was higher in the statin group(P=0.003).Conclusions:Statins have a certain inhibitory effect on the progression of carotid atherosclerotic plaques,including delaying the increase of plaque burden,the aggravation of arterial lumen stenosis.It also has a stabilizing effect on carotid plaques,including reducing the occurrence of vulnerable plaques and promoting plaque calcification.