高分辨率磁共振检测颅内动脉粥样硬化易损斑块与中老年复发脑梗死的关系
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摘要
目的通过高分辨率磁共振成像(HRMRI)技术分析颅内动脉粥样硬化(ICAD)斑块性质,初步探讨ICAD斑块与复发脑梗死(RCI)的关系。方法选取2016年1月至2017年11月在本院住院的由头颈MRA或CTA证实存在大脑中动脉或基底动脉中重度狭窄的脑梗死患者61例,其中男性36例,女性25例,年龄45～73岁,平均年龄(61.7±6.1)岁。所有患者分为初发脑梗死(PCI)患者28例和RCI患者33例,所有脑梗死患者均行HRMRI检查,根据不同信号特点分析ICAD斑块性质,区分不稳定斑块和稳定斑块。观察两组颅内不稳定斑块情况,Logistic回归分析颅内不稳定斑块与RCI的相关性。结果(1) RCI组和PCI组之间基线临床特征比较,RCI组年龄、2型糖尿病、高血压病比例显著高于PCI组,差异有统计学意义(P<0.05),其余差异无统计学意义;(2) RCI组不稳定斑块比例明显高于PCI组,差异有统计学意义(P<0.05);(3) Logistic回归分析显示,除了年龄、2型糖尿病外,颅内不稳定斑块是RCI的独立危险因素(OR为18.088,95%CI为2.587～126.450,P值为0.004)。结论颅内易损斑块与RCI密切相关,重视中老年脑梗死患者颅内不稳定斑块的检测,有助于预测RCI的风险,为二级预防提供临床依据。
Objective To explore the relationship between intracranial atherosclerotic(ICAD) plaque character analyzed by high resolution magnetic resonance imaging(HRMRI) and recurrent cerebral infarction(RCI). Method A total of 61 cerebral infarction patients(36men; age 45-73 years; mean age, 61.7years±6.1[standard deviation]) with ≥ 50% middle cerebral artery(MCA) or basilar artery(BA) stenosis identified by CTA were selected at admission from January 2016 to November 2017. They were divided into two groups: patients with primary cerebral infarction(PCI)group(n=28) and RCI group(n=33). All patients underwent HRMRI of ICAD plaque. According to different signal characteristics, unstable plaque or stable plaque were distinguished. ICAD unstable plaque in two groups were observed. Logistic regression analysis was used to study the correlation between ICAD unstable plaque and RCI. Results(1) Comparison of clinical baseline between RCI group and PCI group, age, type 2 diabetes mellitus and hypertension in RCI-group were significantly higher than these in PCI group(P<0.05);(2) Compared with PCI group, unstable plaques in RCI group was significantly higher(P<0.05);(3) Logistic regression analysis showed that, in addition to age and type 2 diabetes mellitus, ICAD unstable plaque is an independent risk factor for RCI(OR:18.088, 95%CI:2.587-126.450, P=0.004). Conclusion ICAD vulnerable plaque is closely related to RCI. Paying attention to the detection of ICAD unstable plaques in middle-aged and elderly patients with RCI is helpful to predict the RCI and provide more basis and guidance for clinical secondary prevention.
Objective To explore the relationship between intracranial atherosclerotic(ICAD) plaque character analyzed by high resolution magnetic resonance imaging(HRMRI) and recurrent cerebral infarction(RCI). Method A total of 61 cerebral infarction patients(36men; age 45-73 years; mean age, 61.7years±6.1[standard deviation]) with ≥ 50% middle cerebral artery(MCA) or basilar artery(BA) stenosis identified by CTA were selected at admission from January 2016 to November 2017. They were divided into two groups: patients with primary cerebral infarction(PCI)group(n=28) and RCI group(n=33). All patients underwent HRMRI of ICAD plaque. According to different signal characteristics, unstable plaque or stable plaque were distinguished. ICAD unstable plaque in two groups were observed. Logistic regression analysis was used to study the correlation between ICAD unstable plaque and RCI. Results(1) Comparison of clinical baseline between RCI group and PCI group, age, type 2 diabetes mellitus and hypertension in RCI-group were significantly higher than these in PCI group(P<0.05);(2) Compared with PCI group, unstable plaques in RCI group was significantly higher(P<0.05);(3) Logistic regression analysis showed that, in addition to age and type 2 diabetes mellitus, ICAD unstable plaque is an independent risk factor for RCI(OR:18.088, 95%CI:2.587-126.450, P=0.004). Conclusion ICAD vulnerable plaque is closely related to RCI. Paying attention to the detection of ICAD unstable plaques in middle-aged and elderly patients with RCI is helpful to predict the RCI and provide more basis and guidance for clinical secondary prevention.
引文
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[9]何思锦,李颖彬,张燕婷,等.采用高分辨率磁共振评价颅内动脉粥样硬化斑块稳定性与卒中复发风险的关系[J].中国脑血管病杂志,2017,14(7):351-355.
[10]Chung J W,Hwang J,Lee M J,et al.Previous statin use and high-resolution magnetic resonance imaging characteristics of intracranial atherosclerotic plaque:the intensive statin treatment in acute ischemic stroke patients with intracranial atherosclerosis study[J].Stroke,2016,47(7):1789-1796.
[2]全国第四届脑血管病学术会议.脑卒中患者临床神经功能缺损程度评分标准(1995)[J].中华神经科杂志,1996,29(6):379-381.
[3]Saba L,Anzidei M,Sanfilippo R,et al.Imaging of the carotid artery[J].Atherosclerosis,2012,220(2):294-309.
[4]Turan TN,LeMatty T,Martin R,et al.Characterization of intracranial atherosclerotic stenosis using high resolution MRI study-rationale and design[J].Brain Behav,2015,5(12):e00397.
[5]肖章红,丁立东,柯开富.颈动脉粥样硬化斑块对脑梗死患者病情及其复发的影响[J].临床神经病学杂志,2015,28(4):269-272.
[6]王占强,李叶丹,李春宇,等.中国人群颈动脉粥样硬化与脑梗死复发关系的Meta分析[J].中国全科医学,2010,13(7B):2187-2189.
[7]Zhao DL,Deng G,Xie B,et al.High-resolution MRI of the vessel wall in patients with symptomatic atherosclerotic stenosis of the middle cerebral artery[J].J Clin Neurosci,2015,22(4):700-704.
[8]Bodle JD,Feldmann E,Swartz RH,et al.High-resolution mangnetic resonance imaging:an emerging tool evaluating intracranial aterial disease[J].Stroke,2013,44(1):287-292.
[9]何思锦,李颖彬,张燕婷,等.采用高分辨率磁共振评价颅内动脉粥样硬化斑块稳定性与卒中复发风险的关系[J].中国脑血管病杂志,2017,14(7):351-355.
[10]Chung J W,Hwang J,Lee M J,et al.Previous statin use and high-resolution magnetic resonance imaging characteristics of intracranial atherosclerotic plaque:the intensive statin treatment in acute ischemic stroke patients with intracranial atherosclerosis study[J].Stroke,2016,47(7):1789-1796.