颅内大脑中动脉局灶性与普遍性重塑分析

发布时间：2018-02-02 03:40

  本文关键词： 重塑 颅内动脉粥样硬化 脑白质病变 3D高分辨磁共振 大脑中动脉　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

【摘要】：背景:动脉重塑(Arterial Remodeling)是在冠状动脉和周围动脉粥样硬化发展过程中一种常见的现象。前期研究发现颅内动脉既存在大动脉粥样硬化处局灶扩张或缩窄性重塑,也存在脑小血管病中累及全程血管无斑块的普遍扩张重塑。三维高分辨成像(3D HRMRI)可覆盖整体颅内血管,并减少由于颅内血管走形迂曲造成的测量误差,在研究颅内动脉重塑具有优势。目的:应用三维高分辨成像(3D HRMRI)探索大脑中动脉(Middle Cerebral Artery,MCA)狭窄疾病和脑白质病变的重塑类型和分布规律。方法:回顾性分析了北京协和医院2013-2016年连续收集的大脑中动脉狭窄患者、脑白质病变患者和对照组成年人。在3D HRMRI上测量MCA狭窄处和参照处的管周面积,计算局灶重塑率(Remodeling Ratio,RR),判定局灶重塑类。狭窄的MCA分为犯罪血管(狭窄血管对应供血区域有脑血管事件发生)和非犯罪血管(狭窄血管对应供血区域无脑血管事件发生)。使用3D HRMRI整体测量颅内前循环动脉的管周面积包括:普遍重塑所研究的双侧MCA M1段(采用固定间距连续测量),和基线动脉:双侧大脑前动脉(Anterior CerebralArtery,ACA)及双侧颈内动脉(Internal Carotid Artery,ICA)整体情况。探索对照组、脑白质病变组前循环左、右两侧对称性。各组血管对称指数(Vessel Symmetric Index,VSI)通过计算一侧MCA管周面积平均值比对侧MCA管周面积平均值得到,从而判断MCA狭窄组狭窄侧血管较对侧非狭窄血管是否有整体扩张或缩窄趋势。比较脑白质病变组与对照组MCA连续测量点平均管周面积,判定普遍性重塑类型。结果:本研究入组患者78例,包括:脑白质病变组(Fazekas分级2—3级)17例,大脑中动脉狭窄组35例和对照组26例。对照组、脑白质病变组,前循环各血管左右两侧管周面积均无统计学差异(P0.05)。MCA管周面积近端至远端有统计学差异(P0.05),有逐渐减小的趋势。与对照组MCA管周面积相比,脑白质病变组具有更大的MCA管周面积,管壁面积P(0.05)。大脑中动脉狭窄组中,犯罪血管有更多的扩张性重塑,更大的重塑率,更大的狭窄处管周面积;非犯罪血管有更多的缩窄性重塑,P0.05。与对照组相比,狭窄组VSI具有统计学差异,P0.05。狭窄组VSI(0.87±0.22))小于对照组 VSI(1.00±0.16),为不对称缩窄型(asymmetric constrictive pattern),即狭窄组狭窄侧血管较对侧非狭窄血管管周面积有缩小的趋势。狭窄组VSI亚组分析,其中扩张性重塑患者(n=9),缩窄性重塑患者(n=18),两亚组间血管对称指数(VSI)无统计学差异,P0.05。结论:1)在活体情况下,非粥样硬化的颅内血管呈现血管对称性,其中大脑中动脉管周面积延走形从近段至远端有逐渐减小的趋势。2)颅脑血管疾病的重塑呈现出两种表型:对称性普遍性重塑,见于脑严重白质病变患者;单支血管内的普遍性缩窄性重塑叠加局灶的扩张性或者缩窄性重塑,见于大脑中动脉粥样硬化狭窄。我们推测颅内动脉内的血流流体力学特性是造成重塑异质性重要原因。
[Abstract]:Background: arterial remodeling (Arterial Remodeling) is in the process of coronary artery and peripheral atherosclerosis in the development of a common phenomenon. The preliminary study found that both the existence of large intracranial artery atherosclerosis at the focal dilatation or constrictive remodeling, there is generally no tired and full expansion of remodeling of vascular plaques of cerebral small vessel disease. Three dimensional high resolution imaging (3D HRMRI) can cover the whole intracranial vessels, and reduce the measurement error caused by the shape of intracranial vascular tortuosity, the advantages in the study of intracranial arterial remodeling. Objective: the application of 3D high resolution imaging (3D HRMRI) on the middle cerebral artery (Middle Cerebral, Artery, MCA) stenosis disease and cerebral white matter lesion type and remodeling distribution. Methods: a retrospective analysis of consecutive Peking Union Medical College Hospital 2013-2016 years of middle cerebral artery stenosis in patients with cerebral white matter lesions and the control group of adults. Measurement of MCA stenosis and peripheral area of the tube at the 3D HRMRI in the reference, the calculation of focal remodeling rate (Remodeling Ratio, RR), to determine the focal remodeling. The narrow MCA divided into crime (vascular stenosis corresponding supply region cerebrovascular events) and vascular stenosis (non criminal blood vessel corresponding blood supply area no cerebral vascular events). Using 3D HRMRI overall measurement of anterior circulation intracranial peritubular area include: bilateral MCA M1 segment of common remodeling (using continuous measurement of fixed spacing), and baseline artery: bilateral anterior cerebral artery (Anterior, CerebralArtery, ACA) and bilateral internal carotid artery (Internal Carotid Artery, ICA) the overall situation of exploration. In control group, cerebral white matter lesion of anterior circulation left and right sides of each symmetry. Symmetry index (Vessel Symmetric vascular Index, VSI) the average value of the contralateral MCA area by calculating the average value of peritubular side MCA peritubular area 寰楀埌,浠庤，

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