应用高分辨率磁共振成像对颅内动脉狭窄斑块危险因素的临床研究

发布时间：2018-08-13 19:43

【摘要】：目的:脑卒中在我国人口死亡原因中占第二位,其发病率高、复发率高、致残率高和死亡率高,给社会及家庭带来沉重的负担。其中,以缺血性卒中最为常见。在国内,颅内动脉粥样硬化疾病(intracranial atherosclerotic disease,ICAD)是最常见的缺血性卒中。在国外,ICAD的致死率较前下降,而在我国,其发病率和复发率都呈逐年增高的趋势,成为目前临床上急需解决的医学难题之一。颅内动脉粥样硬化(intracranial atherosclerosis,ICAS)是指脑底部动脉出现一系列改变进而导致临床事件的发生,包括内膜损伤、脂质聚集、纤维增生,进一步导致管壁增厚,管腔狭窄。探讨ICAS引发脑卒中的机制,可以达到预测缺血性脑卒中风险,指导早期预防治疗并减少脑卒中发生的目的。因此对ICAS斑块性质进行进一步研究,进而采用有针对性治疗方案,具有重要的临床意义。目前传统的血管检查技术(血管彩超、经颅多普勒、磁共振血管造影、螺旋CT血管造影、脑血管造影术)仅能显示颅外动脉粥样硬化斑块情况,不能检测ICAS斑块,无法进一步区分斑块的稳定性,限制了临床进行颅内动脉斑块的研究。随着近年来医学影像技术的发展,高分辨率磁共振成像(high-resolution magnetic resonance imaging,HR-MRI)检查作为一种新型检查项目,能清晰的显示动脉血管管壁的形态及成分,具有较高的特异性及灵敏性。本研究旨在通过HR-MRI检查明确颅内动脉粥样硬化性狭窄斑块的性质,研究脑血管病危险因素与斑块稳定性之间的关系,为缺血性脑血管病二级预防提供依据。方法:选择2016年01月至2017年02月期间,于我院住院的符合入组标准的伴有颅内动脉粥样硬化性血管狭窄的缺血性脑血管病患者共59例,收集患者的脑血管病危险因素(年龄、性别、吸烟、高血压病、糖尿病、冠心病、体重指数、hs-CRP、低密度脂蛋白胆固醇及甘油三酯),行HR-MRI检查后根据斑块性质分为稳定性斑块组(n=36)和不稳定性斑块组(n=23)。分别对两组患者的危险因素进行单因素和多因素分析,研究脑血管病危险因素与颅内动脉粥样硬化性狭窄斑块稳定性的相关性。统计学分析采用SPSS 17.0统计学软件。计量资料:正态分布以均数±标准差表示,非正态分布以中位数(四分位数间距)表示。两组比较采用两个独立样本t检验或t′检验。计数资料以频数、率或百分比(%)表示,两组比较采用χ2检验。多因素分析采用logistic回归分析,P0.05表示差异有统计学意义。结果:1两组患者单因素分析不稳定斑块组中吸烟及糖尿病患者均明显高于稳定斑块组,差异有统计学意义(吸烟:卡方值5.281,P=0.022;糖尿病:卡方值4.768,P=0.029)。而两组其他临床资料之间,并无统计学差异。2对以上脑血管病危险因素进行多因素logistic回归分析吸烟[P=0.021,OR值(95%CI)=3.983(1.234-12.860)]及糖尿病[P=0.027,OR值(95%CI)=3.753(1.161-12.134)]为不稳定性斑块的危险因素。结论:1 3.0T HR-MRI能够对颅内动脉粥样硬化斑块进行定性分析,判定斑块的易损性,为脑血管病的预防和治疗提供一种新的科学依据。2 ICAS斑块的易损性与吸烟、糖尿病有明显相关性,出现进展性卒中及脑卒中复发风险更高,所以防止颅内动脉粥样硬化及斑块的形成需强调早期戒烟及强化糖尿病管理,会在脑血管疾病的预防和治疗中起到重要作用。
[Abstract]:Objective: Stroke is the second leading cause of death in China. It has a high incidence, high recurrence rate, high disability rate and high mortality rate, which brings heavy burden to society and families. Among them, ischemic stroke is the most common. In China, intracranial atherosclerotic disease (ICAD) is the most common ischemia. In foreign countries, the fatality rate of ICAD has declined earlier. In China, the incidence and recurrence rate of ICAD have been increasing year by year, which has become one of the medical problems that need to be solved urgently. To explore the mechanism of ICAS-induced stroke can predict the risk of ischemic stroke, guide early prevention and treatment and reduce the incidence of stroke. Therefore, further study on the nature of ICAS plaque, and then adopt targeted. At present, the traditional angiographic techniques (color Doppler, transcranial Doppler, magnetic resonance angiography, spiral CT angiography, cerebral angiography) can only show the situation of extracranial atherosclerotic plaques, can not detect ICAS plaques, can not further distinguish the stability of plaques, limiting clinical progress. With the development of medical imaging technology in recent years, high-resolution magnetic resonance imaging (HR-MRI) is a new type of examination, which can clearly show the morphology and composition of the arterial wall and has high specificity and sensitivity. HR-MRI was used to determine the nature of intracranial atherosclerotic stenosis plaque, and to study the relationship between risk factors of cerebrovascular disease and plaque stability, so as to provide evidence for secondary prevention of ischemic cerebrovascular disease. The risk factors (age, sex, smoking, hypertension, diabetes, coronary heart disease, body mass index, hs-CRP, low density lipoprotein cholesterol and triglyceride) were collected from 59 patients with ischemic cerebrovascular disease. The patients were divided into stable plaque group (n=36) and unstable plaque group (n=36) according to the nature of the plaque. Group (n = 23). Univariate and multivariate analyses were performed to study the correlation between the risk factors of cerebrovascular disease and the stability of intracranial atherosclerotic stenosis plaques. SPSS 17.0 was used for statistical analysis. Statistical data: Normal distribution was expressed by mean (+) standard deviation, and non-normal distribution was expressed by median. Two independent sample t test or t'test were used for comparison between the two groups. Counting data were expressed by frequency, rate or percentage (%) and_2 test was used for comparison between the two groups. Multivariate analysis was used for logistic regression analysis. P 0.05 showed significant difference between the two groups. Smoking: Chi-square value 5.281, P = 0.022; diabetes: Chi-square value 4.768, P = 0.029). There was no significant difference between the two groups in other clinical data. 2 Multiple logistic regression analysis of the above risk factors of cerebrovascular disease smoking [P = 0.021, OR (95% CI) = 3.983 (1.983). 234-12.860) and diabetes mellitus [P = 0.027, OR value (95% CI) = 3.753 (1.161-12.134)] were risk factors for unstable plaques. Conclusion: 13.0T HR-MRI can be used to qualitative analysis of intracranial atherosclerotic plaques, determine the vulnerability of plaques, and provide a new scientific basis for the prevention and treatment of cerebrovascular diseases. Smoking and diabetes mellitus are significantly associated with a higher risk of recurrence of progressive stroke and stroke. Therefore, prevention of intracranial atherosclerosis and plaque formation should emphasize early smoking cessation and strengthening diabetes management, which will play an important role in the prevention and treatment of cerebrovascular diseases.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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