摘要目的 通过分析动态对比增强磁共振(DCE MR)参数Ktrane,探讨其评价他汀类药物治疗老年人颈动脉斑块稳定性疗效的价值. 方法 经颈动脉B超筛选出37例颈动脉存在低回声或混合回声斑块的老年患者,根据2011欧洲心脏病学会(ESC)和欧洲动脉粥样硬化学会(EAS)血脂异常管理指南标准分为低密度脂蛋白胆固醇(LDL-C)达标组和未达标组,1周内行3.0T磁共振颈动脉粥样硬化斑块对比增强扫描,测量两组患者的斑块面积、脂核大小、DCE-MR对比剂容积转移常数(Ktrans)和血清高敏C反应蛋白(hs-CRP)水平. 结果 LDL-C达标组的斑块面积、脂核面积、脂核百分比≥40％、Ktrans、hs-CRP均小于未达标组,分别为(2.06±0.45)mm2比(3.63±0.62) mm2、(0.52±0.05) mm2比(1.49±0.01) mm2、2例(11.8％)比14例(70.0％)、(0.041±0.009)min-1比(0.079±0.011)min-1、(1.60±0.27) mmol/L比(2.80±0.34) mmol/L,差异有统计学意义(均P＜0.05);Ktrans与脂核大小(r=0.19,P＞0.05)、hs-CRP(r=0.23,P＞0.05)均无相关性. 结论 结论DCE-MR技术是一种可对动脉粥样硬化斑块组分进行量化的方法;Ktrans可成为衡量斑块稳定性的新指标;他汀类药物通过抗斑块滋养血管增生、抗炎和减小脂核达到稳定斑块的作用.

abstractsObjective To investigate the efficacy of statin on carotid plaque stability in elderly patients assessed by K trans (the combination of E and F) of dynamic contrast material enhanced (DCE) magnetic resonance (DCE MR) imaging.Methods 37 elderly patients with carotid artery of low echo or mixed echo plaque in carotid artery patches were screened by B type ultrasound.According to the standard of 2011 ESC/EAS guidelines,all patients were divided into two groups:normal level of LDL-C group achieving LDL-C target and high level of LDL C group not achieving target of LDLC.Plaque area and size of lipid-rich necrotic core were measured by 3.0T enhancement magnetic resonance,and K trans was measured by DCE-MR dynamic contrast material enhanced (DCE) magnetic resonance (MR) imaging.and serum hs-C-reactive protein level was detected within 1 week.Results Plaque area,size of lipid-rich necrotic core,ratio of lipoid core over plaque area,K trans and serum level of hs-CRP were less in normal LDL-C level group than in high LDL-C level group [(2.06±0.45) mm2 vs.(3.63±0.62) mm2,(0.52±0.05) mm2 vs.(1.49±0.01) mm2,2 cases (11.8％) vs.14 cases (70.0％),(0.041±0.009) min1 vs.(0.079±0.011) min-1,(1.60±0.27) mmol/L vs.(2.80 ± 0.34),all P＜0.05].Linear regression analysis revealed that there was no significant correlations of K trans with the size of lipid necrotic core (r=0.19,P＞0.05) and hs-CRP (r=0.23,P＞0.05).Conclusions Dynamic contrast material enhanced (DCE) magnetic resonance (MR) imaging is a quantitative method assaying atheromatous plaque components; K trans may be a new indicator to measure the stability of plaques; Statin can stabilize plaques through inhibiting the proliferation of Vasa vasorum in plaque angiogenesis,anti-inflammatory and reducing the size of lipidrich necrotic core.