本文關(guān)鍵詞： 重塑 顱內(nèi)動脈粥樣硬化 腦白質(zhì)病變 3D高分辨磁共振 大腦中動脈　出處：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文　論文類型：學(xué)位論文

【摘要】：背景:動脈重塑(Arterial Remodeling)是在冠狀動脈和周圍動脈粥樣硬化發(fā)展過程中一種常見的現(xiàn)象。前期研究發(fā)現(xiàn)顱內(nèi)動脈既存在大動脈粥樣硬化處局灶擴(kuò)張或縮窄性重塑,也存在腦小血管病中累及全程血管無斑塊的普遍擴(kuò)張重塑。三維高分辨成像(3D HRMRI)可覆蓋整體顱內(nèi)血管,并減少由于顱內(nèi)血管走形迂曲造成的測量誤差,在研究顱內(nèi)動脈重塑具有優(yōu)勢。目的:應(yīng)用三維高分辨成像(3D HRMRI)探索大腦中動脈(Middle Cerebral Artery,MCA)狹窄疾病和腦白質(zhì)病變的重塑類型和分布規(guī)律。方法:回顧性分析了北京協(xié)和醫(yī)院2013-2016年連續(xù)收集的大腦中動脈狹窄患者、腦白質(zhì)病變患者和對照組成年人。在3D HRMRI上測量MCA狹窄處和參照處的管周面積,計(jì)算局灶重塑率(Remodeling Ratio,RR),判定局灶重塑類。狹窄的MCA分為犯罪血管(狹窄血管對應(yīng)供血區(qū)域有腦血管事件發(fā)生)和非犯罪血管(狹窄血管對應(yīng)供血區(qū)域無腦血管事件發(fā)生)。使用3D HRMRI整體測量顱內(nèi)前循環(huán)動脈的管周面積包括:普遍重塑所研究的雙側(cè)MCA M1段(采用固定間距連續(xù)測量),和基線動脈:雙側(cè)大腦前動脈(Anterior CerebralArtery,ACA)及雙側(cè)頸內(nèi)動脈(Internal Carotid Artery,ICA)整體情況。探索對照組、腦白質(zhì)病變組前循環(huán)左、右兩側(cè)對稱性。各組血管對稱指數(shù)(Vessel Symmetric Index,VSI)通過計(jì)算一側(cè)MCA管周面積平均值比對側(cè)MCA管周面積平均值得到,從而判斷MCA狹窄組狹窄側(cè)血管較對側(cè)非狹窄血管是否有整體擴(kuò)張或縮窄趨勢。比較腦白質(zhì)病變組與對照組MCA連續(xù)測量點(diǎn)平均管周面積,判定普遍性重塑類型。結(jié)果:本研究入組患者78例,包括:腦白質(zhì)病變組(Fazekas分級2—3級)17例,大腦中動脈狹窄組35例和對照組26例。對照組、腦白質(zhì)病變組,前循環(huán)各血管左右兩側(cè)管周面積均無統(tǒng)計(jì)學(xué)差異(P0.05)。MCA管周面積近端至遠(yuǎn)端有統(tǒng)計(jì)學(xué)差異(P0.05),有逐漸減小的趨勢。與對照組MCA管周面積相比,腦白質(zhì)病變組具有更大的MCA管周面積,管壁面積P(0.05)。大腦中動脈狹窄組中,犯罪血管有更多的擴(kuò)張性重塑,更大的重塑率,更大的狹窄處管周面積;非犯罪血管有更多的縮窄性重塑,P0.05。與對照組相比,狹窄組VSI具有統(tǒng)計(jì)學(xué)差異,P0.05。狹窄組VSI(0.87±0.22))小于對照組 VSI(1.00±0.16),為不對稱縮窄型(asymmetric constrictive pattern),即狹窄組狹窄側(cè)血管較對側(cè)非狹窄血管管周面積有縮小的趨勢。狹窄組VSI亞組分析,其中擴(kuò)張性重塑患者(n=9),縮窄性重塑患者(n=18),兩亞組間血管對稱指數(shù)(VSI)無統(tǒng)計(jì)學(xué)差異,P0.05。結(jié)論:1)在活體情況下,非粥樣硬化的顱內(nèi)血管呈現(xiàn)血管對稱性,其中大腦中動脈管周面積延走形從近段至遠(yuǎn)端有逐漸減小的趨勢。2)顱腦血管疾病的重塑呈現(xiàn)出兩種表型:對稱性普遍性重塑,見于腦嚴(yán)重白質(zhì)病變患者;單支血管內(nèi)的普遍性縮窄性重塑疊加局灶的擴(kuò)張性或者縮窄性重塑,見于大腦中動脈粥樣硬化狹窄。我們推測顱內(nèi)動脈內(nèi)的血流流體力學(xué)特性是造成重塑異質(zhì)性重要原因。
[Abstract]:Background: arterial remodeling (Arterial Remodeling) is in the process of coronary artery and peripheral atherosclerosis in the development of a common phenomenon. The preliminary study found that both the existence of large intracranial artery atherosclerosis at the focal dilatation or constrictive remodeling, there is generally no tired and full expansion of remodeling of vascular plaques of cerebral small vessel disease. Three dimensional high resolution imaging (3D HRMRI) can cover the whole intracranial vessels, and reduce the measurement error caused by the shape of intracranial vascular tortuosity, the advantages in the study of intracranial arterial remodeling. Objective: the application of 3D high resolution imaging (3D HRMRI) on the middle cerebral artery (Middle Cerebral, Artery, MCA) stenosis disease and cerebral white matter lesion type and remodeling distribution. Methods: a retrospective analysis of consecutive Peking Union Medical College Hospital 2013-2016 years of middle cerebral artery stenosis in patients with cerebral white matter lesions and the control group of adults. Measurement of MCA stenosis and peripheral area of the tube at the 3D HRMRI in the reference, the calculation of focal remodeling rate (Remodeling Ratio, RR), to determine the focal remodeling. The narrow MCA divided into crime (vascular stenosis corresponding supply region cerebrovascular events) and vascular stenosis (non criminal blood vessel corresponding blood supply area no cerebral vascular events). Using 3D HRMRI overall measurement of anterior circulation intracranial peritubular area include: bilateral MCA M1 segment of common remodeling (using continuous measurement of fixed spacing), and baseline artery: bilateral anterior cerebral artery (Anterior, CerebralArtery, ACA) and bilateral internal carotid artery (Internal Carotid Artery, ICA) the overall situation of exploration. In control group, cerebral white matter lesion of anterior circulation left and right sides of each symmetry. Symmetry index (Vessel Symmetric vascular Index, VSI) the average value of the contralateral MCA area by calculating the average value of peritubular side MCA peritubular area 寰楀埌,浠庤，

本文編號：1483536