基于高分辨磁共振血管壁成像的症状性大脑中动脉粥样硬化斑块特征与脑卒中复发风险关系研究  

Correlation of characteristics of symptomatic middle cerebral artery plaques with risk of stroke recurrence:Study based on high-resolution vessel wall imaging

作　　者：曾星星 王莉蓉 高志国 鲁金飞 蒋小莉 李小依 ZENG Xing-xing;WANG Li-rong;GAO Zhi-guo;LU Jin-fei;JIANG Xiao-li;LI Xiao-yi(Department of Neurology,Yichang Central People's Hospital,Yichang 443003,Hubei Province,China;Department of Radiology,Jingmen People's Hospital,Jingmen 448000,Hubei Province,China)

机构地区：[1]宜昌市中心人民医院神经内科,湖北宜昌443003 [2]荆门市人民医院影像科,湖北荆门448000

出　　处：《医疗卫生装备》2025年第2期63-67,共5页Chinese Medical Equipment Journal

基　　金：荆门市科技局引导项目(2023YDKY038)。

摘　　要：目的:研究基于高分辨磁共振血管壁成像(high-resolution vessel wall imaging,HR-VWI)的症状性大脑中动脉(middle cerebral artery,MCA)粥样硬化斑块特征与脑卒中复发风险的关系。方法:前瞻性选取2019年1月至2022年8月在荆门市人民医院及宜昌市中心人民医院因急性缺血性脑卒中(acute ischemic stroke,AIS)和短暂性脑缺血发作(transient ischemic attack,TIA)的住院患者83例。所有患者均给予抗血小板聚集和强化他汀类药物降脂治疗,随访过程中若患者新出现同一责任血管区域的神经功能缺损症状或经颅脑弥散加权成像(diffusion weighted imaging,DWI)检查证实有新的梗死灶,则判断为AIS或TIA复发,以此划分复发组和非复发组。复发组患者在复发2周内进行HRVWI扫描并继续接受他汀类药物治疗,非复发组患者接受他汀类药物治疗半年后进行HR-VWI复查。比较所有患者接受他汀类药物治疗前后的临床指标,对复发组和非复发组患者的基线数据进行单因素分析,并对复发相关的高危因素进行Logistic回归分析。采用SPSS 22.0软件进行统计学分析。结果:接受他汀类药物治疗半年后,所有患者的总胆固醇(total cholesterol,TC)、甘油三酯(triglycerides,TG)较治疗前有所降低,管腔狭窄率、T1WI高信号、斑块负荷、斑块强化率较治疗前有所好转,美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分较治疗前有所改善,差异有统计学意义(P均<0.05)。单因素分析结果显示,复发组患者有更高的斑块强化率(P=0.012)及更大的斑块负荷(P=0.047),差异有统计学意义;2组患者的管腔狭窄率、T1WI高信号、斑块厚度、重构指数比较差异无统计学意义(P均>0.05)。多因素Logistic回归分析显示,斑块强化率与6个月内脑卒中复发独立相关(P=0.027)。结论:HR-VWI可以有效评估复发性脑卒中患者MCA斑块特征,较高的斑块强化率可作为评估脑卒中�Objective To investigate the correlation of the characteristics of symptomatic middle cerebral artery plaques with the risk of stroke recurrence based on high-resolution vessel wall imaging(HR-VWI).Methods Totally 83 patients hospitalized for acute ischemic stroke(AIS)and transient ischemic attack(TIA)at Jingmen People's Hospital and Yichang Central People's Hospital from January 2019 to August 2022 were selected prospectively,who all underwent the treatment with antiplatelet aggregation and intensive lipid lowering by statins.During the follow-up,AIS or TIA recurrences were determined in case of newly found symptoms of neurological impairment in the same supply area of the responsible vessel or new infarct foci confirmed by cranial diffusion weighted imaging(DWI).The patients with AIS or TIA recurrences were enrolled into a recurrence group,and the remained ones were divided into a non-recurrence group.The recurrence group went through HR-VWI scanning within two weeks of recurrence and statin treatment,and the non-recurrence group was examined with HR-VWI half a year after receiving statin treatment.All the patients had their clinical indexes compared before and after statin treatment,the baseline data of the two groups underwent univariate analysis,and Logistic regression analysis was performed for the high-risk factors related to recurrence.SPSS 22.0 software was used for statistical analysis.Results After six months of statin treatment,all the patients were improved in TC,TG,luminal stenosis rate,high T1WI signal,plaque burden,plaque enhancement rate and NIHSS score,with the differences being significant(all P<0.05).Univariate analysis showed the recurrence group had higher plaque enhancement rates(P=0.012)and higher plaque burden(P=0.047)when compared with the non-recurrence group,with the differences being significant;the two groups were not statistically different in luminal stenosis rate,high T1WI signal,plaque thickness and remodeling index(all P>0.05).Multivariate logistic regression analysis indicated

关 键 词：脑卒中 高分辨磁共振血管壁成像 大脑中动脉 粥样硬化 斑块特征 脑卒中复发 

分 类 号：R318[医药卫生—生物医学工程] R445.2[医药卫生—基础医学]