CAJ | 학술논문

目的分析颈内动脉起始部粥样硬化斑块周围血流动力学改变,探讨可能导致纤维帽破裂的流体力学因素.方法前瞻性纳入19例颈内动脉起始部粥样硬化病变患者,进行颈动脉MRI.观察斑块形态结构,并据此将斑块分为纤维帽完整组和纤维帽破裂组.利用颈动脉MR增强血管成像原始图像进行血流动力学分析,计算颈动脉分叉部血管管壁切应力(WSS)、静态压、血管狭窄率等数据,两组之间比较采用两独立样本的Mann-Whitney U检验和t检验.结果 19例颈内动脉起始部斑块中,纤维帽完整组8例、斑块纤维帽破裂11例.纤维帽完整组最大管壁切应力、平均管壁切应力、最小静态压及平均静态压对应的中位数(上下四分位数范围)分别为42.92(27.13～68.19)、32.04(21.21～55.68)、-1 717.36(-3 433.61～-721.10)、-1 341.64(-2 868.00～-612.86)Pa,纤维帽破裂组对应的数据分别为67.18(60.46～139.51)、55.76(40.41～124.57)、-3884.02(-18767.39～-2886.33)、-3065.92(-16064.18～-1 915.09)Pa,两组间差异有统计学意义(U值分别为18.00、18.00、17.00、18.00,P值均＜0.05).斑块纤维帽完整组和纤维帽破裂组颈内动脉狭窄率分别为(47.13±13.50)％、(62.91±11.96)％,两组之间比较差异有统计学意义(t=2.69,P=0.02).结论破裂与非破裂颈动脉粥样硬化斑块间的血流动力学存在差异,可能会对斑块破裂造成影响.
목적 분석경내동맥기시부죽양경화반괴주위혈류동역학개변,탐토가능도치섬유모파렬적류체역학인소.방법 전첨성납입19례경내동맥기시부죽양경화병변환자,진행경동맥MRI.관찰반괴형태결구,병거차장반괴분위섬유모완정조화섬유모파렬조.이용경동맥MR증강혈관성상원시도상진행혈류동역학분석,계산경동맥분차부혈관관벽절응력(WSS)、정태압、혈관협착솔등수거,량조지간비교채용량독립양본적Mann-Whitney U검험화t검험.결과 19례경내동맥기시부반괴중,섬유모완정조8례、반괴섬유모파렬11례.섬유모완정조최대관벽절응력、평균관벽절응력、최소정태압급평균정태압대응적중위수(상하사분위수범위)분별위42.92(27.13～68.19)、32.04(21.21～55.68)、-1 717.36(-3 433.61～-721.10)、-1 341.64(-2 868.00～-612.86)Pa,섬유모파렬조대응적수거분별위67.18(60.46～139.51)、55.76(40.41～124.57)、-3884.02(-18767.39～-2886.33)、-3065.92(-16064.18～-1 915.09)Pa,량조간차이유통계학의의(U치분별위18.00、18.00、17.00、18.00,P치균＜0.05).반괴섬유모완정조화섬유모파렬조경내동맥협착솔분별위(47.13±13.50)％、(62.91±11.96)％,량조지간비교차이유통계학의의(t=2.69,P=0.02).결론 파렬여비파렬경동맥죽양경화반괴간적혈류동역학존재차이,가능회대반괴파렬조성영향.
Objective To assess the role of hemodynamic change in the carotid atherosclerotic plaque rupture.Methods Nineteen patients with carotid atherosclerotic plaque were recruited in this study.All the plaques were divided into two groups,the intact plaques and the ruptured plaques using carotid MRI.Wall shear stress and static pressure near the plaques obtained by computational fluid dynamics were compared between two groups by using Mann-Whitney U test.Results Nineteen plaques in the internal carotid arteries were obtained,including 8 intact plaques and 11 ruptured plaques.The median (interquartile range) of maximal wall shear stress,mean wall shear stress,minimal static pressure and mean static pressure in the intact plaques were 42.92 (27.13 to 68.19),32.04(21.21 to 55.68),-1 717.36(-3 433.61 to-721.10),-1 341.64(-2 868.00 to-612.86) Pa,respectively.The median (interquartile range) of maximal wall shear stress,mean wall shear stress,minimal static pressure and mean static pressure in the ruptured plaques were 67.18(60.46 to 139.51),55.76(40.41 to 124.57),-3 884.02(-18 767.39 to-2 886.33),-3 065.92 (-16 064.18 to-1 915.09) Pa,respectively.There were significant differences in the four parameters between the two groups (U=18.00,18.00,17.00,18.00;P＜0.05).Conclusion The hemodynamics between ruptured and intact plaques is different,which may have influence on carotid atherosclerotic plaque rupture.