无症状性颈动脉狭窄患者血脑屏障通透性变化的研究  

Study on changes of blood brain barrier permeability in asymptomatic carotid artery stenosis patients

作　　者：阴晓坤 叶靖 于海龙 陈蓓蕾 YIN Xiaokun;YE Jing;YU Hailong(Department of Neurology,Subei people's Hospital,Yangzhou 225001,China)

机构地区：[1]扬州大学附属苏北人民医院神经内科,江苏扬州225001 [2]扬州大学附属苏北人民医院医学影像科,江苏扬州225001 [3]滨州医学院烟台附属医院神经内科,山东烟台264199

出　　处：《中风与神经疾病杂志》2023年第1期29-33,共5页Journal of Apoplexy and Nervous Diseases

基　　金：扬州科技发展计划(YZ2020081)。

摘　　要：目的 使用动脉自旋标记(ASL)灌注成像技术、动态对比增强磁共振成像(DCE-MRI)技术及人工智能脑结构分析平台,探讨无症状性颈动脉狭窄(ACAS)患者脑灌注、血脑屏障(BBB)通透性、灰质体积的变化及相关性。方法 对纳入研究的40例ACAS患者进行MRI检查,通过ASL技术评估患者两侧大脑半球脑血流灌注的情况,通过DCE-MRI技术评估两侧大脑半球BBB通透性(用容积转运常数Ktrans值表示)的变化,并通过人工智能脑结构分析平台计算颈动脉供血区域的灰质体积。将以上数据以及患者的临床资料进行统计分析和检验。结果 与对侧相比,ACAS患者颈动脉狭窄侧的脑灌注降低(P<0.001),且Ktrans值升高(P<0.05)。除此之外,ACAS患者颈动脉狭窄侧大脑皮质灰质的体积小于对侧(P<0.001),其中颞叶、额叶、顶叶及岛叶灰质体积相比差异均具有统计学意义(均P<0.05)。相关性分析结果显示,ACAS患者颈动脉狭窄侧的Ktrans值与CBF值之间具有负相关关系(r=-0.334,P<0.05)。结论 ACAS患者存在狭窄侧颈动脉供血区的低灌注及BBB通透性增高,同时存在相应供血区的大脑皮质灰质体积的萎缩。且颈动脉狭窄侧的BBB通透性增高与低灌注有关。Objective To investigate the changes and correlations of the permeability of blood brain barrier(BBB),the cerebral brain perfusion and the volume of gray matter in patients with asymptomatic carotid artery stenosis(ACAS) by arterial spin labeling(ASL) MRI,dynamic contrast-enhanced(DCE) MRI and artificial intelligence.Methods ASL-MRI,DCE-MRI and three-dimension brain volume(3D-BRAVO) imaging were performed respectively on 40 patients with ACAS,then transferred them to the workstation for image post-processing to obtain cerebral blood perfusion, BBB permeability(which was expressed by volume transport constant Ktrans) and gray matter volume of both side.The above data were statistically analyzed and tested.Results Compared with the contralateral side, the stenosed side had a significant lower cerebral brain perfusion(P<0.001) and higher Ktrans value(P<0.05) in patients with ACAS.The volume of gray matter of the stenosed side was significantly smaller than the contralateral side(P<0.001),there were significant differences between bilateral temporal lobe, frontal lobe, parietal lobe and insular lobe(all P<0.05).Correlation analysis shows there was a negative correlation between Ktrans value and CBF value on the stenosed side(r=-0.334,P<0.05).Conclusion In patients with ACAS,there are lower cerebral brain perfusion and higher BBB permeability in the stenosed side.The increase BBB permeability in the stenosed side in patients with ACAS is related to the decrease in cerebral brain perfusion.

关 键 词：颈动脉狭窄 磁共振成像 血脑屏障 脑低灌注 脑萎缩 

分 类 号：R743[医药卫生—神经病学与精神病学]