阿司匹林或他汀类药物与未破裂颅内动脉瘤瘤壁强化的横断面分析
本研究基于三个前瞻性未破裂颅内动脉瘤随访登记数据，纳入1351例患者共1416个动脉瘤，采用3T磁共振血管壁成像评估动脉瘤壁强化（AWE）。多因素有序logistic回归显示，阿司匹林使用与AWE可能性降低独立相关（OR=0.51），而他汀类使用无显著关联；倾向性评分匹配后结果一致。横断面设计限制因果推断。
要点
- 阿司匹林使用与未破裂颅内动脉瘤瘤壁强化概率降低独立相关。
- 他汀类药物使用与瘤壁强化无显著统计学关联。
- 3T MR-VWI可用于评估动脉瘤壁强化，辅助风险分层。
关键影像表现/征象
- 瘤壁强化分为无强化、局灶性强化（强化限于部分瘤壁）和环形强化（强化累及整个瘤壁）。
诊断标准与关键数值
- 阿司匹林使用定义为至少100 mg、每周至少3次、持续至少6个月。
- 他汀类使用定义为每日至少20 mg、持续至少6个月。
- 全队列中阿司匹林使用与AWE降低相关（OR=0.51；95%CI，0.35-0.74），他汀类使用无显著关联（OR=1.44；95%CI，0.98-2.12）。
- 倾向性评分匹配后（阿司匹林组83对，他汀组97对），阿司匹林仍与AWE负相关（OR=0.47；95%CI，0.26-0.85），他汀类仍无关联（OR=1.49；95%CI，0.88-2.50）。
临床应用与阅片要点
- 阅片时按无强化、局灶性强化、环形强化三级分类报告AWE。
- 了解患者阿司匹林使用史可能影响AWE解读，但需结合临床综合判断。
- 他汀类使用与AWE无显著关联，不应据此调整影像判读。
局限性
- 横断面设计无法推断因果关系或直接抗炎效应。
- 仅基于三个前瞻性登记数据，可能存在选择偏倚。
- 药物使用依赖患者报告，可能存在错分偏倚。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVE: To investigate the association between use of aspirin or statins and aneurysm wall enhancement (AWE) on 3T magnetic resonance vessel wall imaging (MR-VWI) in patients with unruptured intracranial aneurysms (UIAs).
METHODS: For this cross-sectional study, we obtained individual patient data from three prospective UIA follow-up registries in which patients underwent 3.0T MR-VWI. Regular medication use was defined as aspirin ≥100 mg at least three times per week for ≥6 months, and statins at ≥20 mg daily for ≥6 months. AWE was classified as no AWE (no visible enhancement), focal AWE (enhancement limited to part of the aneurysm wall), or circumferential AWE (enhancement involving the entire wall). Multivariable ordinal logistic regression was used to assess the association between medication use and AWE in the full cohort. To isolate the effect of each drug, we conducted two separate propensity score matching analyses (PSM): statin users were excluded from the aspirin analysis, and aspirin users from the statin analysis. Logistic regression analyses were repeated within each matched group.
RESULTS: We included 1351 patients with 1416 UIAs, of whom 141 (10.4%) used aspirin and 145 (10.7%) used statin. In the full cohort, multivariable ordinal logistic regression showed that aspirin use was associated with a lower likelihood of AWE (OR=0.51; 95%CI, 0.35-0.74), whereas statin use was not significantly associated with AWE (OR=1.44; 95% CI, 0.98-2.12). PSM based on age, sex, hypertension, diabetes, dyslipidemia, and aneurysm size yielded 83 matched pairs in the aspirin cohort and 97 in the statin cohort. In the matched cohorts, aspirin use remained inversely associated with AWE (OR=0.47; 95% CI, 0.26-0.85), while statin use remained unassociated (OR=1.49; 95% CI, 0.88-2.50).
CONCLUSION: In this cross-sectional analysis, aspirin use was independently associated with reduced AWE in patients with UIAs, while statin use was not. However, the cross-sectional design precludes causal inference regarding a direct anti-inflammatory effect on the aneurysm wall.
引用
- Jiang P, Liu Y, Nie X, et al. Aneurysm Wall Enhancement in Patients With Unruptured Intracranial Aneurysm Using Aspirin or Statins: A Cross-Sectional Analysis of Three Prospective Cohorts. AJNR Am J Neuroradiol. 2026. PMID: 42217839. doi:10.3174/ajnr.A9441
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。