大脑中动脉斑块特征与急性脑缺血的相关性研究  

Association between characteristics of middle cerebral artery plaque and acute cerebral ischemia

作　　者：黄娟[1] 焦晟[1] 陈玉辉[2] 宋焱[1] 张金涛[1] 龚涛[2] 陈敏[1] Huang Juan;Jiao Sheng;Chen Yuhui;Song Yan;Zhang Jintao;Gong Tao;Chen Min(Department of Radiology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China;Department of Neurology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China)

机构地区：[1]北京医院放射科,国家老年医学中心,100730 [2]北京医院神经内科,国家老年医学中心,100730

出　　处：《中华老年医学杂志》2020年第4期408-412,共5页Chinese Journal of Geriatrics

摘　　要：目的:应用高分辨率磁共振成像技术(HR-MRI)探讨大脑中动脉(MCA)粥样硬化斑块特征与急性脑缺血症状的关系。方法:回顾性分析136例经HR-MRI证实MCA有粥样硬化斑块患者的临床及影像数据,男性100例,年龄(60.8±11.4)岁。根据患者2周内MCA供血区是否具有急性缺血症状,将其分为急性症状组73例与无急性症状组63例,比较两组之间的基本人口学特征、临床危险因素、MCA斑块强化程度、斑块最大长度、斑块最大厚度、斑块最大长度与最大厚度的比值及管腔狭窄程度等;二元回归分析MCA斑块特征与相应血管供血区急性缺血症状间的关系。结果:MCA供血区有急性症状组患者糖尿病患病率(50.7%,30/73)较无急性症状组患者(30.2%,19/63)增加(χ^2=5.882,P=0.015),明显强化斑块的发生率[87.7%(64/73)比46.0%(29/63)]增加(χ^2=27.118,P<0.001),且具有更大的斑块最大长度(6.7±3.7)mm比(4.9±2.3)mm(t=-3.330,P=0.001)、斑块最大厚度(1.5±0.8)mm比(1.0±1.0)mm(t=-2.231,P=0.027)及更严重的管腔狭窄程度(66.4±31.3)%比(30.7±25.3)%(t=-7.354,P<0.001)。Logistic回归分析结果显示,MCA强化斑块(OR=4.492,95%CI:1.762~11.449,P=0.002)及管腔狭窄程度(OR=1.032,95%CI:1.018~1.047,P<0.001)与急性缺血症状独立相关。结论:相对于管腔狭窄程度,明显强化斑块与急性缺血症状相关性,斑块明显强化可能是其不稳定性的重要指标。Objective To investigate the relationship between atherosclerotic plaque characteristics of the middle cerebral artery(MCA)and acute cerebral ischemic symptoms by using high-resolution magnetic resonance imaging(HR-MRI).Methods A retrospective analysis of clinical and imaging data was performed in 136 patients[100 males,aged(60.8±11.4)years]with MCA atherosclerotic plaque who underwent HR-MRI.Patients were divided into the acute symptomatic group(n=73)and the non-acute asymptomatic group(n=63)according to whether the patients had acute ischemic symptoms in the MCA territory within two weeks.The basic demographic characteristics,clinical risk factors,MCA plaque enhancement,maximum plaque length,maximum wall thickness,ratio of maximum plaque length to maximum wall thickness and luminal stenosis were compared between the two groups.Binary Logistic regression was used to estimate the association between MCA plaque characteristics and acute ischemic symptoms in the corresponding vascular territory.Results Compared with the non-acute symptomatic group,the acute symptomatic group had a greater prevalence of diabetes mellitus(50.7%or 30/73 vs.30.2%or 19/63,χ^2=5.882,P=0.015),a higher occurrence of enhanced plaques(87.7%or 64/73 vs.46.0%or 29/63,χ^2=27.118,P<0.001),greater maximum plaque length[(6.7±3.7 mm)vs.(4.9±2.3)mm,t=-3.330,P=0.001],greater maximum wall thickness[(1.5±0.8)mm vs.(1.0±1.0)mm,t=-2.231,P=0.027]and more severe luminal stenosis[(66.4±31.3)%vs.(30.7±25.3)%,t=-7.354,P<0.001].Logistic regression analysis showed that MCA enhanced plaque(OR=4.492,95%CI:1.762-11.449,P=0.002)and luminal stenosis(OR=1.032,95%CI:1.018-1.047,P<0.001)were independently associated with acute ischemic symptoms.Conclusions Compared with luminal stenosis,MCA enhanced plaque has a stronger correlation with acute ischemic symptoms and significant plaque enhancement may be an important indication of its instability.

关 键 词：动脉粥样硬化 磁共振成像 脑缺血 

分 类 号：R74[医药卫生—神经病学与精神病学]