高分辨核磁对颈动脉硬化斑块评价的临床研究

发布时间：2018-11-26 13:54

【摘要】：目的:对缺血性脑血管病患者颈动脉硬化斑块行颈动脉高分辨核磁检查,探讨高分辨核磁对颈动脉硬化斑块的诊断价值及其针对颈动脉硬化斑块相关卒中二级预防策略的指导意义。方法:以2016年4月至2016年10月期间在我院神经内科住院的缺血性卒中患者为研究对象,分为A、B两组,A组37例行颈动脉高分辨核磁联合颈动脉超声检查,B组42例行颈动脉超声检查,采集两组患者的一般临床资料、颈动脉高分辨核磁图像和颈动脉超声图像,对高分辨核磁图像采用改良的AHA斑块分型、对超声结果采用超声颈动脉斑块分型进行分析和统计学检验,对比两组患者颈动脉狭窄、稳定斑块和不稳定斑块的检出情况,两组患者同时进行积极二级预防干预,随访患者90天、6个月后颈动脉硬化斑块相关的急性缺血性卒中、TIA的发生率。结果:1.A、B组两组间临床基线资料、危险因素比较无统计学差异(P0.05);A组患者中颈动脉高分辨核磁检出颈动脉轻度狭窄15例(20.27%)、中度狭窄7例(9.46%)、重度狭窄16例(21.62%),总体检出率51.35%;A组患者中颈动脉超声检出颈动脉轻度狭窄14例(18.92%)、中度狭窄9例(12.16%)、重度狭窄7例(9.46%),总体检出率(40.54%);B组患者颈动脉超声检出颈动脉轻度狭窄15例(17.86%)、中度狭窄7例(8.33%)、重度狭窄8例(9.52%),总体检出率(35.71%)。高分辨核磁与颈动脉超声比较,颈动脉轻度、中度狭窄检出率无统计学差异(20.27%VS 17.86%,P0.05),重度狭窄检出率高分辨核磁显著高于颈动脉超声(21.62%VS 9.52%,P0.05)。2.采用改良的AHA斑块分型方法对A组患者颈动脉高分辨核磁图像进行评估,发现易损斑块(IV-V型、VI型)32例、稳定斑块(I-II、III、VII、VIII型)34例,易损斑块检出率为48.48%;A组患者行颈动脉超声检出易损斑块24例,检出率为36.36%,B组患者行颈动脉超声检出易损斑块22例,稳定斑块55例,易损斑块检出率为28.57%。组间比较,颈动脉高分辨核磁与颈动脉超声对易损斑块的检出率差异显著(48.48%VS 28.57%,P=0.014)。3.分别以两组患者颈动脉斑块评估结果为指导行相应二级预防干预,以90天、6个月内出现颈动脉硬化斑块相关的脑梗死、TIA作为终点事件,组间比较,A组患者(n=35)短期内颈动脉硬化斑块相关的脑梗死、TIA发生率显著低于B组(n=38)(14.28%VS 36.84%,P=0.028)。结论:1.与基础筛查手段的颈动脉超声比较,高分辨核磁对于缺血性脑血管病相关的颈动脉狭窄及颈动脉易损斑块具有更高的诊断价值。2.以颈动脉高分辨核磁易损斑块检出为依据的二级预防策略,可更好的降低缺血性脑血管病相关颈动脉狭窄患者的卒中发病率。
[Abstract]:Objective: to study the carotid atherosclerotic plaques in patients with ischemic cerebrovascular disease by high resolution nuclear magnetic resonance (HRNMR). To explore the diagnostic value of high resolution nuclear magnetic resonance (HRNMR) in carotid atherosclerotic plaque and the guiding significance of secondary prevention strategy for carotid plaque related stroke. Methods: patients with ischemic stroke hospitalized in our department of neurology from April 2016 to October 2016 were divided into two groups: group A (37 cases) received carotid high-resolution nuclear magnetic resonance (HRM) combined with carotid ultrasound. In group B, 42 patients were examined by carotid ultrasound, and the general clinical data of the two groups were collected. The high resolution nuclear magnetic resonance images and ultrasound images of the carotid artery were collected. The modified AHA plaque classification was used for the high resolution magnetic resonance images. The results of ultrasound were analyzed and statistically tested by ultrasonic carotid plaque classification. The detection of carotid artery stenosis, stable plaque and unstable plaque was compared between the two groups. Incidence of TIA in patients with acute ischemic stroke associated with plaque-related carotid atherosclerosis 6 months after 90 days follow-up. Results: 1. There was no significant difference in the clinical baseline data and risk factors between the two groups (P0.05). In group A, there were 15 cases (20.27%) with mild carotid stenosis, 7 cases (9.46%) with moderate stenosis and 16 cases (21.62%) with severe stenosis by high resolution NMR. The overall detection rate was 51.35%. In group A, 14 cases (18.92%) had mild carotid stenosis, 9 cases (12.16%) had moderate stenosis, 7 cases (9.46%) had severe stenosis, and the overall detection rate was 40.54%. In group B, mild stenosis of carotid artery was detected in 15 cases (17.86%), moderate stenosis in 7 cases (8.33%) and severe stenosis in 8 cases (9.52%). The overall detection rate was 35.71%. Compared with carotid ultrasound, there was no significant difference in the detection rate of mild and moderate stenosis of carotid artery (20.27%VS 17.86). The detection rate of severe stenosis was significantly higher than that of carotid ultrasound (21.62%VS 9.52% P 0.05). The modified AHA plaque classification method was used to evaluate carotid high-resolution nuclear magnetic resonance imaging in group A. The results showed that 32 cases of vulnerable plaques (IV-V type, VI type) and 34 cases of stable plaques (I-III-IIII-VIII-VIII) were found. The detectable rate of vulnerable plaque was 48.48%; In group A, 24 cases of vulnerable plaques were detected by carotid artery ultrasound, 22 cases of group B were detected by carotid artery ultrasound, 55 cases of stable plaques and 28.57% of vulnerable plaques were detected. There was significant difference in the detection rate of vulnerable plaque between carotid high-resolution nuclear magnetic resonance (HRNMR) and carotid ultrasound (48.48%VS 28.57P0. 014). 3. According to the results of carotid plaque evaluation in two groups, the two groups were treated with the corresponding secondary prevention intervention. The cerebral infarction associated with carotid plaque appeared within 90 days and 6 months, and TIA was taken as the endpoint event, and the comparison between the two groups was made. The incidence of TIA in group A was significantly lower than that in group B (n = 38) (14.28%VS 36.84 / P0. 028). Conclusion: 1. Compared with the basic screening method of carotid ultrasound, high resolution magnetic resonance (HRNMR) has higher diagnostic value for carotid stenosis and carotid plaque associated with ischemic cerebrovascular disease (ICVD). 2. The secondary prevention strategy based on the detection of carotid artery high resolution magnetic susceptibility plaque can better reduce the incidence of stroke in patients with ischemic cerebrovascular disease associated carotid artery stenosis.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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