无症状性脑动脉狭窄引起低灌注时脑深部白质血脑屏障通透性的改变  

Changes of blood-brain barrier permeability of the deep white matter during hypoperfusion caused by asymptomatic cerebral artery stenosis

作　　者：任桃杰 瞿小锋 孙士富 吉玉刚 王礼玲 高阳 Ren Taojie;Qu Xiaofeng;Sun Shifu;Ji Yugang;Wang Liling;Gao Yang(Department of Neurology,First People's Hospital of Yancheng City,Yancheng 224006,China;Imaging Department,First People's Hospital of Yancheng City,Yancheng 224006,China)

机构地区：[1]盐城市第一人民医院神经内科,224006 [2]盐城市第一人民医院影像科,224006

出　　处：《中华神经医学杂志》2021年第6期598-604,共7页Chinese Journal of Neuromedicine

摘　　要：目的探讨无症状性脑动脉狭窄引起低灌注时脑深部白质血脑屏障(BBB)通透性的改变情况。方法收集盐城市第一人民医院神经内科自2017年1月至2020年4月收治的36例无症状的单侧颈内动脉或大脑中动脉重度狭窄且CT灌注成像(CTP)显示脑组织中有局部低灌注的患者的CTP影像,在侧脑室体层面及半卵圆中心层面勾画感兴趣区(ROI),包括最大密度投影(MIP)图上狭窄侧深部白质的前部(ROIa)、中间(ROIm)、后部(ROIp)及对比剂达峰时间(Tmax)图上狭窄侧深部白质中Tmax看似正常处(ROI1)、Tmax相对延长处(ROI2)、Tmax明显延长处(ROI3),以及其各自对应的健侧镜像区。采用统计学方法比较各ROI间Tmax、脑血流量(CBF)、容量转移常数(Ktrans)等参数的差异。结果在侧脑室体层面,狭窄侧ROIa、ROIm分别与其各自健侧镜像区比较,Tmax明显延长、CBF明显下降、Ktrans明显升高,差异均有统计学意义(P<0.05);在半卵圆中心层面,狭窄侧ROIa、ROIp分别与其各自健侧镜像区比较,Tmax明显延长、CBF明显下降、Ktrans明显升高,差异均有统计学意义(P<0.05)。在侧脑室体层面及半卵圆中心层面,狭窄侧ROI2、ROI3分别与其各自健侧镜像区比较,Tmax明显延长、CBF明显下降、Ktrans明显升高,差异均有统计学意义(P<0.05)。在侧脑室体层面的狭窄侧,与ROIp比较,ROIa、ROIm的Tmax明显延长、CBF明显下降、Ktrans明显升高,差异均有统计学意义(P<0.05);在侧脑室体层面及半卵圆中心层面的狭窄侧,与ROI1比较,ROI2、ROI3的Tmax明显延长、CBF明显下降、Ktrans明显升高,差异均有统计学意义(P<0.05)。结论无症状性脑动脉狭窄引起低灌注时,低灌注区脑深部白质的BBB通透性会明显增加。Objective To investigate the blood-brain barrier(BBB)permeability changes in the deep white matter(DWM)during hypoperfusion caused by asymptomatic cerebral artery stenosis.Methods The CT perfusion weighted imaging(CTP)images of 36 patients with asymptomatic severe stenosis and unilateral internal carotid artery or middle cerebral artery,admitted to our hospital from January 2017 to April 2020,which revealed the prolongation of contrast medium delayed contrast medium max-time(Tmax),were analyzed.The regions of interest(ROIs)in the DWM of CTP images at the body of lateral ventricle and centrum semiovale,were drawn respectively:the anterior DWM(ROIa),middle DWM(ROIm),and posterior DWM(ROIp)in the stenotic side of maximum intensity projection maps;DWM with normal-appeared Tmax(ROI1),DWM with relatively delayed Tmax(ROI2),and DWM with obviously delayed Tmax(ROI3)in the stenotic side of Tmax maps;and their mirrored ROI on the healthy side.Statistical analysis was used to compare the value differences of Tmax,cerebral blood flow(CBF)and transfer constant(Ktrans)between/among the ROIs.Results As compared with the mirrored ROI in the healthy side,respectively,the ROIa and ROIm in the stenotic side had significantly prolonged Tmax,significantly decreased CBF,and significantly increased Ktrans at the body of lateral ventricle(P<0.05).As compared with the mirrored ROI in the healthy side,respectively,the ROIa and ROIp in the stenotic side had significantly prolonged Tmax,significantly decreased CBF,and significantly increased Ktrans at the centrum semiovale(P<0.05).As compared with the mirrored ROI in the healthy side,respectively,the ROI2 and ROI3 in the stenotic side had significantly prolonged Tmax,significantly decreased CBF,and significantly increased Ktrans at the body of lateral ventricle and centrum semiovale(P<0.05).In the stenotic side at the body of lateral ventricle,as compared with the mirrored ROIp,the ROIa and ROIm had significantly prolonged Tmax,significantly decreased CBF,and significantly increased Ktrans(

关 键 词：血脑屏障 通透性 CT灌注成像 脑动脉狭窄 低灌注 脑深部白质 

分 类 号：R743.3[医药卫生—神经病学与精神病学]