大脑中动脉粥样硬化的狭窄度与卒中机制——一项高分辨磁共振研究  

Stroke Mechanisms of Middle Cerebral Artery Plaque in Different Stenosis Rate:a High Resolution Magnetic Resonance Imaging Study

作　　者：虞雁南 许玉园 李明利[2] 高山[1] 冯逢[2] 徐蔚海[1] 

机构地区：[1]北京协和医院神经内科,北京100730 [2]北京协和医院放射科,北京100730

出　　处：《中国卒中杂志》2016年第8期619-625,共7页Chinese Journal of Stroke

基　　金：教育部新世纪优秀青年基金(NCET-12-0069);北京协和医学院青年基金;中央高校青年基金;国家自然科学基金(81471207);首都卫生发展科研专项基金(2014-4-4015)

摘　　要：目的本研究旨在探索大脑中脉（middle cerebral artery，MCA）狭窄率与MCA斑块形态学及梗死类型的相关性，并探索不同狭窄率患者卒中的发生机制。方法连续收集2009-2014年于北京协和医院就诊的2周内发生MCA供血区缺血性卒中并进行高分辨磁共振（high—resolution magnetic resonance imaging，HP．MRI）扫描的患者。纳入MCA M1段存在斑块的患者，排除心源性、颅外大动脉粥样硬化及其他病因的卒中患者。在弥散加权成像（diffusion weighted imaging，DWI）上将梗死类型分为穿支、皮层、分水岭和混合型梗死，并测量梗死体积。在矢状位HRM耻L测量MCAM1段狭窄率，并收集斑块位置、长度、厚度、信号和斑块连续性等形态学指标。将狭窄率〉50％的患者分入重度狭窄组，将狭窄率≤50％的患者归入轻度狭窄组。结果研究共纳入102例患者，其中重度狭窄组39例，轻度狭窄组63例。重度狭窄组患者卒中，穿支梗死14例（35．9％），皮层梗死9例（23．1％），分水岭梗死4例（10．5％），混合型梗死12例（30．8％）；轻度狭窄组患者中，穿支梗死44例（69．8％），皮层梗死8例（12．7％），分水岭梗死5例（5．8％），混合型梗死8例（12．7％），两组构成类型比较，差异有显著性（P=0．014）。与轻度狭窄组比较，重度狭窄组患者斑块更长（P〈0．001）、更厚（P〈0．001）、更多混合信号斑块（P〈0．001）。斑块厚度（P〈0．001，OR 87．792，95％CI 13．120—587．453）和斑块混合信号（P=0．007， OR 7．358，95％ CI 1．725～31．382）是MCA狭窄率〉50％的独立预测因子。重度狭窄组中，梗死体积与斑块表面不连续（P=0．004）相关。轻度狭窄组中，梗死类型与斑块表面不连续（P=0．002）及斑块厚度（P=0．032）相关。且斑块表面不连续是发生栓塞性梗死的独立预测因子（P=0．003，OR 5．778，95％CI 1�Objective To explore the mechanism of stroke in different middle cerebral artery（MCA） stenosis rate, by understanding the association of MCA stenosis rate, MCA plaque morphology and infarct pattern in stroke patients.Methods Patients with ischemic stroke in MCA territory within 2 weeks in Peking Union Medical College Hospital from 2009 to 2014 were consecutively collected. Patients with MCA plaque on high-resolution magnetic resonance imaging（HRMRI） were included, and patients with cardioembolic,extracranial large artery atherosclerotic stroke and other causes of stroke were excluded from the study. The infarct lesions were classified into penetrating artery, cortical, watershed（or border zone） and mixed infarction, and then the infarct volume on diffusion weighted image（DWI）was calculated. On sagittal HRMRI, the stenosis rate of MCA M1 segment, plaque distribution,length, thickness, signal and surface discontinuity were assessed. Patients with stenosis rate 50%were severe stenosis group, and patients with stenosis rate ≤50% were mild stenosis group.Results One hundred and two patients were analyzed, of whom, 39 patients were in severe stenosis group and 63 in mild stenosis group. Severe stenosis group had 14 cases of penetrating artery infarction（35.9%）, 9 cortical infarction（23.1%）, 4 watershed infarction（10.3%） and 12 mixed infarction（30.8%）; mild stenosis group had 44 penetrating artery infarction（69.8%）, 8 cortical infarction（12.7%）, 3 watershed infarction（5.8%） and 8 mixed infarction（12.7%）. The proportion of two groups had significant difference（P =0.014）. The severe stenosis group had longer（P〈0.001）and thicker（P〈0.001） plaques, and more mixed-signal plaques（P〈0.001）. The plaque thickness（P〈0.001, OR 87.792, 95%CI 13.120-587.453） and mixed-signal of plaque（P =0.007, OR 7.358,95%CI 1.725-31.382） were independent predicting factors of MCA stenosis 50%. In severe stenosis group, the infarct volume was related to plaque surface

关 键 词：粥样硬化斑块 高分辨磁共振 脑卒中机制 大脑中动脉 颅内动脉狭窄 

分 类 号：R743.3[医药卫生—神经病学与精神病学]