高分辨率磁共振评价老年人胸主动脉粥样硬化斑块的特征与高血压的相关性

Characterization of atherosclerotic disease in thoracic aorta evaluated by high-resolution vessel wall imaging and the association with hypertension in the elderly

目的探讨老年人群胸主动脉粥样硬化斑块的成分及负荷特征与高血压的相关性。方法该研究的入组人群为60岁以上,且无任何严重心脑血管症状的老年人。所有受试者均进行磁共振胸主动脉多对比度管壁成像。图像判读人员定量测量高血压患者与血压正常者胸主动脉粥样硬化斑块的负荷,定性分析胸主动脉粥样硬化斑块的成分,并比较它们的差异。将胸主动脉分为三段,即升主动脉段(AAO)、主动脉弓段(AOA)以及降主动脉段(DAO)。结果 55例受试者存在胸主动脉粥样硬化斑块,其中高血压组29例,平均年龄(74.2±5.5)岁,16例(55.2%)为男性。高血压组胸主动脉粥样硬化斑块内出血/血栓的发生率显著高于血压正常组(37.9%vs.11.5%,P=0.025)。高血压组胸主动脉三个节段的管腔面积、管壁面积、血管总面积以及最大管壁厚度均大于血压正常组,且差异均具有统计学意义(均P<0.05)。高血压组AOA段(31.7%±5.4%vs.31.4%±4.7%)和DAO段(34.6%±5.4%vs.33.6%±4.3%)的标准化管壁指数均大于血压正常组,且差异亦有统计学意义(均P<0.05)。结论老年人群高血压患者胸主动脉粥样硬化易损斑块的发生率明显高于血压正常者。

Objective To investigate the characteristics of atherosclerotic plaque components and burden in thoracic aorta in the elderly with and without hypertension. Methods Elderly subjects(≥60 years) without serious cerebrovascular diseases were recruited. Thoracic aorta was imaged on MR scanner by acquiring multicontrast sequences. The plaque burden was calculated quantitatively, the composition of plaque in thoracic aorta was evaluated qualitatively, and the differences were compared between the two groups with and without hypertension. The characteristics of plaque among different thoracic aorta segments(AAO: ascending aorta; AOA: aortic arch, and DOA: descending aorta) were determined. Results Of 55 recruited subjects with atherosclerotic plaque in thoracic aorta, 29 were in hypertension group, the mean age was(74.2±5.5) years old, and 16(55.2%) were male. The prevalence of intraplaque hemorrhage/mural thrombus(37.9% vs. 11.5%, P=0.025) in thoracic aortic plaques wassignificantly higher in hypertension group than in normal blood pressure group. The lumen area, wall area, total vessel area, and maximum wall thickness in all three segments were significantly greater in hypertension group than in another group(P<0.05). The NWI in segment of AOA(31.7%±5.4% vs. 31.4%±4.7%) and DAO(34.6%±5.4% vs. 33.6%±4.3%) was larger in hypertension group(P<0.05). Conclusion The incidence of vulnerable plaque in thoracic aorta was significantly higher in the elderly with hypertension.