基于MRI特征预测缺血性脑卒中的复发风险

发布时间：2018-03-20 07:21

本文选题：急性缺血性脑梗死　切入点：梗死复发　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨MR成像在预测脑卒中复发中的价值,评估并确定脑卒中复发的高危人群。材料与方法本研究共纳入57例初发脑卒中患者,均于2012年3月至2013年8月期间行MRI检查。其中19例患者纳入脑梗死复发组,均于首次发病至少一个月后再次发生新的急性梗死,且经DWI证实。如患者临床症状恶化或DWI显示在原梗死灶附近新发急性梗死,但距离首次发病时间不超过1个月,则认为卒中进展而不是复发。余下的38例患者纳入对照组,均经电话随访至少1年,未发现任何新的神经损害症状,并否认再次梗死。汇总并分析两组患者的首诊数据,包括头颅MRI平扫、MRA及颈部血管多普勒超声。8例对照组和2例复发组患者未获得颈部多普勒数据。5例对照组和3例复发组患者未获得MRA数据。比较病灶的大小、数目、位置、责任血管,Willis环的完整性,颅内大动脉狭窄,脑白质稀疏程度,颈内动脉粥样硬化斑块,糖尿病及高血压病史的两组间差异。应用SPSS17.0软件包进行数据分析,PO.05为差异有统计学意义。结果复发组患者初次发病时的平均年龄较对照组高9岁,独立样本t检验显示组间差异具有统计学意义(t=3.2,P=0.002)。根据不同年龄段分组后再次比较,两组仍存在显著性差异(P=0.003),≥65岁组有66.7%(12/18)的患者出现脑卒中复发。两组患者初发病灶的数目、位置、Willis环的完整性、颈内动脉粥样硬化斑块,以及糖尿病和高血压病史情况趋同,组间差异无显著性(P0.05)。两组患者梗死灶的责任动脉存在显著差异(p=0.013),85.7%(6/7例)的大脑中动脉供血区梗死患者复发,7.7%(1/13)的后循环梗死患者复发。复发组与对照组颅内大动脉狭窄(狭窄率50%)发生率分别为73.7%(14/19)和23.7%(9/38),组间差异有显著性(p=0.000)。两组患者脑白质稀疏的分级具有显著性差异(p=0.000)。复发组和对照组分别有0%(0/19)和50%(19/38)的患者显示0级脑白质稀疏；1-3级脑白质稀疏的患者,复发组分别有10.5%(2/19),47.4%(9/19),42.1%(8/19),对照组分别有21.1%(8/38,),21.1%(8/38)和7.9%(3/38)。多因素分析显示,梗死灶的责任血管(OR,2.057；95%CI,1.079-3.922；P=0.029)和脑白质稀疏的严重程度(OR,0.143；95%CI,0.042-0.480；P=0.002)是梗死复发的独立危险因素。结论脑卒中复发的危险因素包括初次发病时患者的年龄(65岁)、梗死灶的责任血管、颅内大动脉狭窄50%和重度脑白质稀疏(2-3级),其中梗死灶的责任血管和严重的脑白质稀疏是脑梗死复发的独立危险因素。高龄、大脑中动脉供血区急性脑梗死、伴有颅内大动脉狭窄50%和3级WML的患者具有较高的梗死复发风险。
[Abstract]:Objective to evaluate the value of Mr imaging in predicting stroke recurrence and to evaluate and identify the high risk population for stroke recurrence. Materials and methods MRI was performed in 57 patients with primary stroke from March 2012 to August 2013, 19 of whom were included in recurrent cerebral infarction group. New acute infarction occurred at least one month after the first onset, and was confirmed by DWI. If the patient's clinical symptoms deteriorated or DWI showed a new acute infarction near the original infarct, but not more than 1 month after the first onset, The remaining 38 patients were included in the control group, all of whom were followed up by telephone for at least one year. No new symptoms of nerve damage were found, and the patients denied reinfarction. The first diagnosis data of the two groups were collected and analyzed. The MRA data were not obtained in 5 cases of control group and 3 cases of recurrent group. The size, number and location of the lesions were compared between the two groups, including head MRI plain scan MRA and cervical vascular Doppler sonography in 8 cases of control group and 2 cases of recurrent group, and 5 cases of control group and 3 cases of recurrent group did not obtain MRA data. There were significant differences between the two groups in the integrity of Willis circle, the stenosis of intracranial arteries, the degree of white matter sparsity, the atherosclerotic plaque of internal carotid artery, the history of diabetes and hypertension. There were significant differences between the two groups by using SPSS17.0 software package to analyze the data of PO.05. Results the average age of the patients in the relapsed group was 9 years higher than that in the control group. The t test of independent sample showed that the difference between the two groups was statistically significant. There was still a significant difference between the two groups. 66.7% of the patients aged over 65 had recurrent stroke. The number of primary lesions, the integrity of Willis circle, the internal carotid atherosclerotic plaque, and the history of diabetes and hypertension were similar in the two groups. There was no significant difference between the two groups (P 0.05). There was a significant difference in the responsible arteries between the two groups. The incidence of narrowing (50%) was 73.714 / 19) and 23.710 / 38 (P = 0.000), respectively. There was a significant difference in white matter sparsity between the two groups (P = 0.0000.000). The patients with recurrent and control groups had 0% white matter sparsity 1-3% and 5019% 38, respectively. Grade A patients with sparse white matter, In the recurrent group, there were 10. 5 / 19 / 47.4% and 42. 1 / 819, respectively. In the control group, there were 21. 1 / 8 / 8 and 21. 1 / 838, respectively. Multivariate analysis showed that the responsible blood vessel of the infarct, OR2.05795CI1.079-3.922P0. 029) and the severity of the white matter 0.14395CI0.042-0.480P0.002) were independent risk factors for the recurrence of infarction. Conclusion the risk factors of stroke recurrence include the age of the patients at the first onset and the responsible vessels of the infarct. Intracranial artery stenosis 50% and severe white matter sparsity grade 2-3 are independent risk factors for recurrence of cerebral infarction, including responsible vessels and severe white matter sparsity in the infarct area, aged, acute cerebral infarction in the middle cerebral artery supply area, and acute cerebral infarction in the middle cerebral artery (MCAA). Patients with intracranial artery stenosis (50% and 3 WML) had a higher risk of infarct recurrence.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3;R445.2

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