【作者】 秦颖；

【导师】 刘尊敬；

【作者基本信息】 北京大学医学部 ， 神经病学， 2021， 硕士

【摘要】 目的:脑卒中是目前世界范围内导致人类死亡的第二大病因。颅内动脉粥样硬化是全世界范围内缺血性脑卒中的最常见病因。颅内动脉粥样硬化不稳定斑块破裂是急性缺血性卒中发生的最重要的危险因素之一,评估不稳定斑块特征并积极干预,有望减少急性缺血性卒中的发生。高分辨磁共振(High-Resolution Magnetic Resonance Imaging)作为一种描述血管管壁结构的成像方式,可评估颅内外动脉管壁结构。本研究主要目的是利用HRMRI评估大脑中动脉(middle cerebral artery,MCA)斑块特征与MCA供血区发生缺血性脑卒中的关系。方法:本文采用回顾性研究的方法,搜集并纳入了 2016年6月至2020年12月于中日友好医院进行HRMRI检查的大脑中动脉狭窄患者。根据DWI轴位结果将研究对象分为卒中组和非卒中组,并比较该两组患者的临床资料。根据HRMRI影像学结果,评估颅内大脑中动脉斑块特点与供血区缺血性卒中的相关性。结果:本研究共计纳入43名患者,根据DWI结果分为卒中组(20例)和非卒中组(23例)。在临床基线数据方面,统计分析结果表明卒中组与非卒中组在年龄、性别、高血压、糖尿病、高脂血症、吸烟、肥胖、卒中/TIA病史等方面没有统计学显著性差异(p>0.05)。卒中组即新发梗死组管壁面积明显高于非卒中组,有显著性统计学差异(p=0.007)。卒中组20例与非卒中组23例总体相比,大脑中动脉斑块负荷卒中组大于非卒中组,差异有统计学意义(p=0.015)。两组大脑中动脉血管狭窄率、偏心指数、偏心斑块方面,两组无统计学差异(p>0.05)。在增强方面,在两组间轻度强化无统计学差异(p=0.431)及中度强化无统计学差异(p=0.146)。斑块明显强化,卒中组18例(90%),非卒中组13例(60.9%),两组之间存在统计学差异(p=0.015)。在偏心明显强化中,卒中组偏心明显强化有14例(70%),非卒中组7例(30.4%),两组间在偏心明显强化存在统计学意义(p=0.010)。卒中组与非卒中组在管壁面积、斑块负荷、明显强化、偏心明显强化方面存在统计学差异。利用logistic回归分析,将有统计学意义的相关因素纳入回归分析,发现与脑梗死相关的因素是发现与新发脑梗死相关的因素是发现与新发脑梗死相关的因素是管壁面积(OR,1.889;95%CI:1.170,3.047;p=0.009)、偏心明显强化(OR,8.116;95%CI:1.669,39.463;p=0.009)。结论:HRMRI可帮助评估MCA狭窄范围内的斑块信号、斑块负荷、强化和偏心指数等指标。评估MCA狭窄范围内的斑块特征,管壁面积、偏心明显强化与新发梗死独立相关,可能是斑块易损性的预测因子。更多还原

【Abstract】 Objective:Stroke is the second leading cause of death worldwide.Intracranial atherosclerosis is the most common cause of ischemic stroke worldwide.As an imaging method to describe the structure of vascular wall,high-resolution Magnetic Resonance Imaging(HRMRI)can evaluate the structure of intracranial and extracranial artery wall.The main purpose of this study was to evaluate the relationship between the characteristics of middle cerebral artery(MCA)plaques and ischemic stroke in the blood supply region by HRMRI.Methods:In this study,patients with middle cerebral artery stenosis who underwent HRMRI examination in China-Japan Friendship Hospital from June 2016 to December 2020 were included.According to the results of DWI,the subjects were divided into stroke group and non-stroke group,and the clinical data of the two groups were compared.Based on HRMRI imaging results,the association between the characteristics of intracranial common cerebral artery plaques and ischemic stroke was assessed.Results:A total of 43 patients were included in this study,which were divided into stroke group(20 cases)and non-stroke group(23 cases)according to DWI results.In terms of clinical baseline data,statistical analysis results showed that there were no statistically significant differences in age,gender,hypertension,diabetes,hyperlipidemia,smoking,obesity,and history of stroke/TIA between the stroke group and the non-stroke group(P>0.05).The wall area of the stroke group was significantly higher than that of the non-stroke group(P=0.007).Compared with 23 cases in the non-stroke group,the plaque load of the middle cerebral artery in the stroke group was higher than that in the non-stroke group,with statistical significance(P=0.015).There was no significant difference in the stenosis rate,eccentric index and eccentric plaque of the middle cerebral artery between the two groups(P>0.05).In the enhancement,there was no statistical difference between the two groups for mild enhancement(P=0.431)and moderate enhancement(P=0.146).There were 18 patients(90%)in the apoplexy group and 13 patients(60.9%)in the non-apoplexy group,and there was a statistical difference between the two groups(P=0.015).Among the obvious enhancement of eccentricity,there were 14 cases(70%)in the stroke group and 7 cases(30.4%)in the non-stroke group,and there was statistical significance in the obvious enhancement of eccentricity between the two groups(P=0.010).There were statistical differences between the stroke group and the non-stroke group in vessel wall area,plaque load,obvious enhancement,and obvious enhancement of eccentricity.Logistic regression analysis was used,and statistically significant factors were included in the regression analysis.It was found that the factors associated with cerebral infarction were the factors associated with new cerebral infarction,and the factors associated with new cerebral infarction were the wall area(OR,1.889;95%CI:1.170,3.047;P=0.009),eccentricity significantly enhanced(OR,8.116;95%CI:1.669,39.463;P=0.009).Conclusion:HRMRI can help to evaluate the plaque signal,plaque burden,enhancement,and eccentricity index of MCA stenosis.In the range of stenosis of MCA,wall area,significant enhancement of eccentricity were independently associated with new infarct and may be predictors of plaque vulnerability.更多还原