复发性急性脑梗死颈动脉斑块的MRI特点及相关危险因素的研究

发布时间：2018-05-11 07:35

本文选题：颈动脉斑块 + 责任血管　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:利用MRI高分辨技术对初发组与复发组急性脑梗死患者的颈动脉粥样硬化斑块进行分析,比较两组患者责任侧与非责任侧颈动脉粥样硬化斑块的稳定性、斑块内部成分、分布部位及颈动脉狭窄程度,并对脑梗死复发的多个相关危险因素分析探讨,以帮助临床积极治疗并预防脑卒中的再发。方法:选取2013.10-2014.10期间于天津医科大学第四中心临床学院神经内科住院的急性前循环脑梗死患者48例,根据患者有无脑梗死病史将患者分为初发组和复发组。其中初发组患者22例,复发组患者26例,两组患者的性别、年龄等一般资料具有可比性。所有患者均接受3.0 MRI双侧颈动脉检查,分别获得3D-TOF亮血技术、T1WI、T2WI和3D MP-RAGE黑血技术序列图像。对两组患者所得图像进行分析,比较两组患者的责任侧与非责任侧颈血管的动脉粥样硬化斑块的类型及稳定性、斑块内部成分、分布情况及颈动脉狭窄程度。记录两组患者入院时的NHISS评分及血压、血糖等实验室检查结果,采集两组患者既往吸烟、高血压史、短暂性脑缺血发作史、糖尿病病史、高血脂病史等相关危险因素。采用SPSS 21.0统计软件,两组间计数资料采用c2检验,两组间计量资料采用独立样本t检验,以P0.05认为差异有统计学意义。结果:1.两组患者责任侧颈血管斑块比较:(1)复发组患者责任侧颈血管的颈动脉粥样硬化不稳定斑块较初发组患者明显增多,差异有统计学意义(42.9%vs.12.5%,P0.05)。(2)复发组患者责任侧颈血管的斑块纤维帽破裂(25%vs.4.2,P0.05)和斑块内出血的发生率(32.1%vs.4.2%,P0.05)较初发组患者明显增多。(3)复发组患者责任侧颈血管的斑块分布情况与初发组患者比较未见明显差异。(4)复发组患者责任侧颈动脉重度狭窄的发生率较初发组患者明显增多,差异有统计学意义(40%vs.9.5%,P0.05)。初发组患者责任侧颈动脉轻度狭窄的发生率较复发组患者增多,差异有统计学意义(66.7%vs.20%,P0.05)。2.两组患者非责任侧颈血管斑块的稳定性、斑块成分、分布情况及颈动脉狭窄程度之间的比较未见明显差异(P0.05)。3.复发组患者入院时NHISS评分高于初发组患者(5.23±2.05 vs.3.00±2.43,P0.05)。4.初发组患者与复发组患者在年龄、性别、吸烟史、冠心病史之间的差异无统计学意义。两组患者高血压病史的患病率比较差异无统计学意义,但是复发组患者入院时的收缩压明显高于初发组患者(151.65±1.27 vs.139.10±1.87,P0.05)。复发组患者TIA史和糖尿病史的患病率明显高于初发组患者(P0.05)。复发组患者空腹血糖和糖化血红蛋白、总胆固醇、低密度脂蛋白、同型半胱氨酸、超敏C反应蛋白和叶酸水平明显高于初发组(P0.05),复发组患者高密度脂蛋白水平明显低于初发组(P0.05)。舒张压、甘油三酯和维生素B12的水平在两组间无明显差异(P0.05)。结论:1.利用3.0T高分辨MRI可对颈动脉粥样硬化斑块稳定性情况进行定性分析,有助于评估脑梗死再发的风险。2.复发组患者与初发组患者责任侧颈血管的颈动脉粥样硬化斑块成分存在差异,复发组患者责任侧颈血管的不稳定斑块包括斑块纤维帽破裂和斑块内出血的发生率高于初发组患者。复发组患者责任侧颈血管重度狭窄的比例明显高于初发组患者。3.初发组患者与复发组患者非责任侧颈血管的颈动脉粥样硬化斑块情况和颈动脉狭窄程度间无显著差异。4.复发组患者入院时NIHSS评分高于初发组患者。5.糖尿病、TIA史、收缩压、高血脂、高同型半胱氨酸血症、高C反应蛋白是脑梗死复发的危险因素,对这些危险因素加以控制可以预防脑梗死的复发。
[Abstract]:Objective: to analyze the carotid atherosclerotic plaque in the patients with acute cerebral infarction in the primary and recurrent groups by MRI high resolution technique, and compare the stability of the atherosclerotic plaque in the two groups of patients with the responsibility side and the non responsible side of the carotid artery, the internal components of the plaque, the distribution of the plaque and the narrowing of the carotid artery, and the multiple related risks for the recurrence of cerebral infarction. Method: 48 patients with acute anterior cerebral infarction hospitalized in the neurology department of the fourth center of Medical University Of Tianjin, Medical University Of Tianjin, were divided into primary and recurrence groups according to the history of cerebral infarction in the fourth Center Clinical College of Medical University Of Tianjin. 22 cases, 26 cases in the recurrent group, the gender, age and other general data of the two groups were comparable. All patients received 3 MRI bilateral carotid artery examination, respectively obtained the 3D-TOF technique of bright blood, T1WI, T2WI and 3D MP-RAGE black blood technical sequence images. The images of the two groups of patients were analyzed, and the responsibility side and non responsibility of the two groups were compared. The type and stability of atherosclerotic plaque in the lateral cervical vessels, the internal composition of the plaque, the distribution of the plaque and the degree of carotid stenosis. The NHISS scores and blood pressure, blood sugar and other laboratory results were recorded in the two groups of patients, and the previous smoking, hypertension, the history of transient ischemic attack, the history of diabetes, hyperlipidemia and hyperlipidemia were collected in two groups of patients. History and other related risk factors. Using the SPSS 21 statistical software, the two groups of counting data were tested by C2 test, and the two groups used independent sample t test, and the difference was statistically significant with P0.05. Results: 1. two groups of patients were compared with the responsible lateral cervical plaque: (1) the unstable plaque of carotid atherosclerosis in the recurrent group. The difference was statistically significant (42.9%vs.12.5%, P0.05). (2) the incidence of plaque rupture of plaque (25%vs.4.2, P0.05) and plaque bleeding (32.1%vs.4.2%, P0.05) in the recurrent group was significantly higher than that in the primary group. (3) the plaque distribution of the responsible lateral cervical vessels in the recurrent group and the patients in the recurrent group. There was no significant difference in the patients in the primary group. (4) the incidence of severe stenosis in the recurrent carotid artery in the recurrent group was significantly higher than that in the primary group (40%vs.9.5%, P0.05). The incidence of mild carotid artery stenosis in the primary group was more than that of the recurrent group (66.7%vs.20%, P0.05). .2. two groups of patients with non responsible lateral neck vascular plaque stability, plaque composition, distribution and carotid stenosis, there was no significant difference (P0.05) the NHISS score in the patients with.3. recurrence was higher than that of the primary group (5.23 + 2.05 vs.3.00 + 2.43, P0.05) in the early.4. group and the relapsed group in age, sex, smoking history, There was no statistical difference between the history of coronary heart disease. There was no significant difference in the prevalence rate of hypertension in the two groups, but the systolic pressure of the patients in the relapse group was significantly higher than that in the primary group (151.65 + 1.27 vs.139.10 + 1.87, P0.05). The incidence of TIA and diabetes in the recurrent group was significantly higher than that in the primary group (P 0.05). The levels of fasting blood glucose and glycosylated hemoglobin, total cholesterol, low density lipoprotein, homocysteine, hypersensitivity C reaction protein and folic acid were significantly higher in the recurrent group than in the primary group (P0.05). The level of HDL in the recurrent group was significantly lower than that in the primary group (P0.05). The diastolic pressure, triglyceride and vitamin B12 levels were no more in the two groups. Significant differences (P0.05). Conclusion: 1. the stability of carotid atherosclerotic plaques can be qualitatively analyzed with 3.0T high resolution MRI. It is helpful to evaluate the risk of carotid atherosclerotic plaque in the responsible lateral neck of patients with recurrent cerebral infarction and the primary group of.2.. The incidence of plaque rupture and bleeding in the plaque was higher than that in the primary group. The proportion of severe stenosis in the recurrent group was significantly higher than that in the primary.3. group and the non responsible carotid artery atherosclerotic plaque and the degree of carotid stenosis in the patients with the recurrent group and the recurrent group. The NIHSS score of the patients with different.4. recurrence was higher than that of.5. diabetes, TIA, systolic blood pressure, hyperlipidemia, hyperhomocysteinemia, and high C reactive protein as a risk factor for the recurrence of cerebral infarction.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.33;R445.2

【参考文献】