利用高分辨管壁成像探索大脑中动脉斑块特性及其临床意义
发布时间：2018-07-31 16:25
【摘要】：背景：颅内动脉粥样硬化(Intracranial atherosclerotic disease, ICAD)是亚洲人群卒中的首要病因。高分辨管壁成像(High resolution vessel wall imaging, HRVWI)可无创地观察颅内血管壁、管腔、斑块形态和斑块内成分,在判断ICAD患者斑块易损性、预测临床预后方面具有很大的潜力。目的：利用HRVWI探索ICAD患者梗死类型、大脑中动脉(Middle cerebral artery, MCA)狭窄程度与斑块、管壁及重塑特点间的相关性,以阐明ICAD患者卒中的病理生理机制。方法：本研究回顾性分析2009至2015年于北京协和医院连续收集的缺血性脑卒中患者和既往无卒中病史的患者。症状组的纳入标准包括发病时间≤2周的MCA供血区梗死,以及HRVWI上患侧MCA M1段的偏心性斑块。无症状组的纳入标准包括既往无卒中病史和HRVWI上MCA M1段的偏心性斑块。根据症状组患者梗死类型,分为穿支梗死组、栓塞性梗死组和孤立的白质区梗死组(不纳入下一步分析)。在HRVWI上测量MCA M1段最狭窄层面的管腔面积、血管外围面积、斑块分布(斑块累及上、下、前、后四个象限)、斑块长度、斑块厚度、斑块信号和斑块表面不连续等影像学标记物,选取相对正常的血管横断面作为参照点,测量参照点管腔面积和参照点外围面积。计算斑块指数(斑块累及象限数之和)、管壁面积、狭窄率和重塑率。将穿支梗死组及栓塞性梗死组的影像学标记物分别与无症状组进行单因素分析和logistic回归分析。结果：共纳入患者232例,其中症状组113例,无症状组119例。症状组中,穿支梗死组54例,栓塞性梗死组52例。三组中狭窄率与斑块长度、厚度和斑块指数显著相关(p0.05)。穿支梗死组和无症状组中,狭窄率与缩窄性重塑显著相关(p0.05)。栓塞性梗死组和无症状组中,管壁面积与狭窄率显著相关(p0.05)。单因素分析提示,与无症状组相比,穿支梗死组的斑块累及下壁、前壁和后壁更少(p0.05),最厚点位于上壁的斑块更多(p0.05),管腔面积更大(p0.001),斑块指数更低(p0.001)。二元logistic回归分析显示,斑块最厚点位于上壁(p=0.003, OR 3.158,95%CI 1.490-6.690),管腔面积(p=0.005, OR 1.315, 95%CI 1.089-1.589)和斑块指数(p=0.010, OR 0.575,95%CI 0.378-0.874)是穿支梗死组的独立预测因素。与无症状组相比,栓塞性梗死组的斑块累及前壁和后壁更多(p0.05),斑块长度、厚度更大(p0.001),信号混杂和表面不连续的斑块更多(p0.05),狭窄率更大(p0.001),更多扩张性重塑(p0.01),管壁面积更大(p0.001),管腔面积更小(p0.01),斑块指数更大(p0.01)。二元logistic回归分析显示狭窄率(p=0.008, OR 9.996,95%CI 2.141-46.665)、斑块长度(p=0.003, OR 1.295,95%CI 1.068-1.569)和扩张性重塑(p=0.002, OR 3.785, 95%CI 1.601-8.947)是栓塞性梗死的独立预测因素。在轻度狭窄组中,栓塞性梗死有更多斑块表面不连续和扩张性重塑(p0.05),且斑块表面不连续为栓塞性梗死的唯一独立预测因素(p=0.016, OR 5.146,95%CI 1.354-19.533)。结论：1)不同梗死类型与无症状组之间,随狭窄率升高,管壁面积的变化和重塑类型不同。2)与无症状组相比较,穿支梗死组的独立预测因素包括最厚点位于上壁的斑块,斑块指数和管腔面积,提示最厚点位于上壁的斑块是一种特殊类型的高危板块；边缘累及上壁的斑块不易发生穿支梗死；血管的普遍重塑可能在不同卒中机制中起到一定作用。3)栓塞性梗死组的独立预测因素为狭窄率、斑块长度和扩张性重塑;其中管腔轻度狭窄的患者中,斑块表面不连续是栓塞性梗死的独立预测因素,提示斑块破裂所致的栓塞性梗死可能是轻度ICAD患者的重要卒中机制,可用于隐源性卒中的病因分析。
[Abstract]:Background: Intracranial atherosclerotic disease (ICAD) is the leading cause of stroke in Asian population. High resolution tube wall imaging (High resolution vessel wall imaging, HRVWI) can noninvasive observation of intracranial vascular wall, lumen, plaque morphology and intrapular components. It can predict plaque vulnerability in ICAD patients and predict clinical symptoms. The prognosis has great potential. Objective: To explore the correlation between the infarct type, the degree of Middle cerebral artery (MCA), the degree of Middle cerebral artery (MCA) and the characteristics of the wall and remodeling of the Middle cerebral artery, in order to clarify the pathophysiological mechanism of the stroke in ICAD patients. Methods: a retrospective analysis of the Beijing Concorde doctors from 2009 to 2015 in this study. A hospital continuous collection of ischemic stroke patients and patients who had no history of stroke in the past. The inclusion criteria of the symptom group included the MCA blood supply area infarction at the onset of 2 weeks and the eccentricity plaque on the MCA M1 segment on the side of the HRVWI. The inclusion criteria of the asymptomatic group included the past history of stroke and the eccentricity of the MCA M1 segment on HRVWI. Patients with infarct type were divided into perforator infarction group, embolic infarction group and isolated white matter area infarction group (not included in the next step analysis). On the HRVWI, the narrowest layer of lumen area, peripheral area of blood vessel, plaque distribution (plaque involvement, lower, four quadrants), plaque length, plaque thickness, plaque signal and plaque were measured on the MCA M1 segment. Surface discontinuity and other imaging markers were used to select the relative normal vascular cross sections as reference points, to measure the area of the lumen and the peripheral area of the reference point at the reference point. The plaque index (the sum of the plaques involving the quadrant), the area of the tube wall, the stenosis rate and the remolding rate were calculated. The imaging markers of the perforating and embolic infarction groups were separately and asymptomatic. Results: single factor analysis and logistic regression analysis. Results: 232 cases were included in the patients, including 113 symptomatic and 119 asymptomatic groups, 54 in the perforating infarction group and 52 in the embolic infarction group in the symptom group. The stenosis rate in the three groups was significantly correlated with the plaque length, thickness and plaque index (P0.05). The stenosis rate in the perforator infarction group and the asymptomatic group. There was a significant correlation with constrictive remodeling (P0.05). The area of the tube wall was significantly correlated with the rate of stenosis in the embolic and asymptomatic groups (P0.05). Single factor analysis suggested that the plaque involved the lower wall, the anterior wall and the posterior wall (P0.05), the thicker (P0.05) and greater lumen area (p0.001) in the perforating infarction group than in the asymptomatic group. The plaque index was lower (p0.001). The two yuan logistic regression analysis showed that the thickest spot was in the upper wall (p=0.003, OR 3.158,95%CI 1.490-6.690). The lumen area (p=0.005, OR 1.315, 95%CI 1.089-1.589) and plaque index (p=0.010, OR) were independent predictors of the perforating infarction. Compared with the asymptomatic group, embolic sex The plaque in the infarct group involved the anterior and posterior walls more (P0.05), the plaque length and the thickness (p0.001), the signal confounding and the surface discontinuous patches were more (P0.05), the stenosis rate was greater (p0.001), more dilated remodeling (P0.01), the wall area was larger (p0.001), the lumen area was smaller (P0.01), the plaque index was larger (P0.01). Two yuan logistic regression analysis The stenosis rate (p=0.008, OR 9.996,95%CI 2.141-46.665), plaque length (p=0.003, OR 1.295,95%CI 1.068-1.569) and dilated remodeling (p=0.002, OR 3.785, 95%CI 1.601-8.947) were independent predictors of infarct infarction. In the mild stenosis group, embolic infarction had more plaque surface discontinuity and dilated remodeling. Block surface discontinuity was the only independent predictor of embolic infarction (p=0.016, OR 5.146,95%CI 1.354-19.533). Conclusion: 1) the independent predictors of perforating infarction include the thickest point in the perforating infarction group compared with the asymptomatic group, with the increase of the stenosis rate, the change in the area of the tube wall, and the different type of remodeling type between the asymptomatic group and the asymptomatic group. The plaque, plaque index, and lumen area of the upper wall suggest that the thickest plaque at the upper wall is a special type of high risk plate; the plaque with the edge and the upper wall is not susceptible to perforating infarction; the general remodeling of the blood vessels may play a role in different stroke mechanisms.3) the independent predictor of the thrombus stopper infarction is the narrowing rate. Plaque length and dilatation remodeling; in patients with mild stenosis, plaque surface discontinuity is an independent predictor of embolic infarction, suggesting that embolic infarction caused by plaque rupture may be an important stroke mechanism in mild ICAD patients and can be used to analyze the etiology of cryptogenic stroke.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R743
本文编号：2156143
[Abstract]:Background: Intracranial atherosclerotic disease (ICAD) is the leading cause of stroke in Asian population. High resolution tube wall imaging (High resolution vessel wall imaging, HRVWI) can noninvasive observation of intracranial vascular wall, lumen, plaque morphology and intrapular components. It can predict plaque vulnerability in ICAD patients and predict clinical symptoms. The prognosis has great potential. Objective: To explore the correlation between the infarct type, the degree of Middle cerebral artery (MCA), the degree of Middle cerebral artery (MCA) and the characteristics of the wall and remodeling of the Middle cerebral artery, in order to clarify the pathophysiological mechanism of the stroke in ICAD patients. Methods: a retrospective analysis of the Beijing Concorde doctors from 2009 to 2015 in this study. A hospital continuous collection of ischemic stroke patients and patients who had no history of stroke in the past. The inclusion criteria of the symptom group included the MCA blood supply area infarction at the onset of 2 weeks and the eccentricity plaque on the MCA M1 segment on the side of the HRVWI. The inclusion criteria of the asymptomatic group included the past history of stroke and the eccentricity of the MCA M1 segment on HRVWI. Patients with infarct type were divided into perforator infarction group, embolic infarction group and isolated white matter area infarction group (not included in the next step analysis). On the HRVWI, the narrowest layer of lumen area, peripheral area of blood vessel, plaque distribution (plaque involvement, lower, four quadrants), plaque length, plaque thickness, plaque signal and plaque were measured on the MCA M1 segment. Surface discontinuity and other imaging markers were used to select the relative normal vascular cross sections as reference points, to measure the area of the lumen and the peripheral area of the reference point at the reference point. The plaque index (the sum of the plaques involving the quadrant), the area of the tube wall, the stenosis rate and the remolding rate were calculated. The imaging markers of the perforating and embolic infarction groups were separately and asymptomatic. Results: single factor analysis and logistic regression analysis. Results: 232 cases were included in the patients, including 113 symptomatic and 119 asymptomatic groups, 54 in the perforating infarction group and 52 in the embolic infarction group in the symptom group. The stenosis rate in the three groups was significantly correlated with the plaque length, thickness and plaque index (P0.05). The stenosis rate in the perforator infarction group and the asymptomatic group. There was a significant correlation with constrictive remodeling (P0.05). The area of the tube wall was significantly correlated with the rate of stenosis in the embolic and asymptomatic groups (P0.05). Single factor analysis suggested that the plaque involved the lower wall, the anterior wall and the posterior wall (P0.05), the thicker (P0.05) and greater lumen area (p0.001) in the perforating infarction group than in the asymptomatic group. The plaque index was lower (p0.001). The two yuan logistic regression analysis showed that the thickest spot was in the upper wall (p=0.003, OR 3.158,95%CI 1.490-6.690). The lumen area (p=0.005, OR 1.315, 95%CI 1.089-1.589) and plaque index (p=0.010, OR) were independent predictors of the perforating infarction. Compared with the asymptomatic group, embolic sex The plaque in the infarct group involved the anterior and posterior walls more (P0.05), the plaque length and the thickness (p0.001), the signal confounding and the surface discontinuous patches were more (P0.05), the stenosis rate was greater (p0.001), more dilated remodeling (P0.01), the wall area was larger (p0.001), the lumen area was smaller (P0.01), the plaque index was larger (P0.01). Two yuan logistic regression analysis The stenosis rate (p=0.008, OR 9.996,95%CI 2.141-46.665), plaque length (p=0.003, OR 1.295,95%CI 1.068-1.569) and dilated remodeling (p=0.002, OR 3.785, 95%CI 1.601-8.947) were independent predictors of infarct infarction. In the mild stenosis group, embolic infarction had more plaque surface discontinuity and dilated remodeling. Block surface discontinuity was the only independent predictor of embolic infarction (p=0.016, OR 5.146,95%CI 1.354-19.533). Conclusion: 1) the independent predictors of perforating infarction include the thickest point in the perforating infarction group compared with the asymptomatic group, with the increase of the stenosis rate, the change in the area of the tube wall, and the different type of remodeling type between the asymptomatic group and the asymptomatic group. The plaque, plaque index, and lumen area of the upper wall suggest that the thickest plaque at the upper wall is a special type of high risk plate; the plaque with the edge and the upper wall is not susceptible to perforating infarction; the general remodeling of the blood vessels may play a role in different stroke mechanisms.3) the independent predictor of the thrombus stopper infarction is the narrowing rate. Plaque length and dilatation remodeling; in patients with mild stenosis, plaque surface discontinuity is an independent predictor of embolic infarction, suggesting that embolic infarction caused by plaque rupture may be an important stroke mechanism in mild ICAD patients and can be used to analyze the etiology of cryptogenic stroke.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R743
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