本文選題：腦梗死　切入點(diǎn)：動(dòng)脈粥樣硬化　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探究顱內(nèi)動(dòng)脈斑塊的強(qiáng)化以及其周圍管壁重構(gòu)模式是否與新近腦缺血性事件的發(fā)生存在關(guān)聯(lián),進(jìn)而探索顱內(nèi)動(dòng)脈粥樣硬化疾病(Intracranial Atherosclerotic Disease,ICAD)患者顱內(nèi)不穩(wěn)定斑塊的影像學(xué)指標(biāo),從而指導(dǎo)臨床對(duì)ICAD患者顱內(nèi)動(dòng)脈斑塊進(jìn)行精確評(píng)估,對(duì)其顱內(nèi)不穩(wěn)定斑塊給予預(yù)防性的干預(yù)治療,從而降低腦梗死的發(fā)生率。對(duì)象與方法:納入天津醫(yī)科大學(xué)總醫(yī)院顱內(nèi)動(dòng)脈粥樣硬化型急性腦缺血事件患者29例(急性缺血性腦卒中患者24例,TIA患者5例;其中男25例,年齡范圍41-80歲,平均年齡61.7±9.8歲)。具體納入排除標(biāo)準(zhǔn)如下:1、通過CTA、MRA或者DSA發(fā)現(xiàn)顱內(nèi)大動(dòng)脈狹窄;2、顱內(nèi)狹窄動(dòng)脈腦供血區(qū)域內(nèi)DWI上發(fā)現(xiàn)梗塞灶或有TIA臨床癥狀;3、確定患者屬于顱內(nèi)大動(dòng)脈類型動(dòng)脈粥樣硬化狹窄;4、排除患者腦缺血癥狀的同側(cè)顱外頸動(dòng)脈(extracranial internal carotid artery,EICA)狹窄大于50%;5、排除其他非動(dòng)脈粥樣硬化型的腦缺血性卒中。所有納入本研究29例患者均在癥狀出現(xiàn)四周之內(nèi)進(jìn)行平掃及增強(qiáng)后3D T1WI-SPACE(three dimensional-T1 weighted imaging-sampling perfection with application optimized contrasts using different flip angle evolutions)及三維時(shí)間飛躍法(three dimensional time-of-flight,3D TOF)MRA影像學(xué)檢查。首先依靠平掃及增強(qiáng)3D T1WI-SPACE、3D TOF MRA來定位29例患者所有顱內(nèi)動(dòng)脈斑塊。然后,根據(jù)DWI上梗塞灶位置或者患者TIA缺血性癥狀,把所有明確的顱內(nèi)斑塊分為責(zé)任斑塊(腦缺血區(qū)域內(nèi)供血?jiǎng)用}的唯一或最狹窄血管病灶)組和非責(zé)任斑塊(血管病灶不在腦缺血區(qū)域供血?jiǎng)用}內(nèi))組;首先所有斑塊依據(jù)在增強(qiáng)3D TIWI-SPACE序列上表現(xiàn)(0級(jí)強(qiáng)化,表示斑塊無強(qiáng)化;1級(jí)強(qiáng)化,斑塊強(qiáng)化程度大于0級(jí)但是強(qiáng)化程度明顯小于正常強(qiáng)化的垂體柄信號(hào)強(qiáng)度;2級(jí)強(qiáng)化,斑塊強(qiáng)化近似或強(qiáng)于正常強(qiáng)化垂體柄信號(hào)強(qiáng)度)被分類并同時(shí)計(jì)算斑塊強(qiáng)化率;其次,依次測(cè)量顱內(nèi)動(dòng)脈斑塊最狹窄處及其參照位置血管的管腔面積(lumen area,LA)、血管外壁面積(outer wall area,OWA)并計(jì)算出管壁面積(wall area,WA);斑塊負(fù)荷就為斑塊最狹窄處WA與OWA測(cè)量值之比;斑塊處管壁重構(gòu)率(remodelling ratio,RR)為斑塊最狹窄處LA與參照位置LA的測(cè)量值之比,重構(gòu)模式分類依據(jù):正性重構(gòu)RR1.05;中間值,0.95≤RR≤1.05;負(fù)性重構(gòu)RR0.95。結(jié)果:1、29例急性腦血管事件患者共計(jì)發(fā)現(xiàn)81個(gè)顱內(nèi)斑塊,其中責(zé)任斑塊29個(gè),非責(zé)任斑塊52個(gè)。所有29個(gè)責(zé)任斑塊均強(qiáng)化(1級(jí)強(qiáng)化38%,2級(jí)強(qiáng)化62%);所有52個(gè)非責(zé)任斑塊中,僅21個(gè)斑塊發(fā)現(xiàn)強(qiáng)化(1級(jí)強(qiáng)化86%,2級(jí)強(qiáng)化14%);經(jīng)過定性分析所有斑塊發(fā)現(xiàn),0級(jí)強(qiáng)化斑塊只存在非責(zé)任斑塊組中,2級(jí)強(qiáng)化與責(zé)任斑塊有一定關(guān)聯(lián)。經(jīng)過定量比較分析,責(zé)任斑塊的強(qiáng)化率與非責(zé)任斑塊的強(qiáng)化率存在顯著的差異性(P0.001);責(zé)任斑塊強(qiáng)化率(0.957±0.33)幾乎是非責(zé)任斑塊強(qiáng)化率(0.429±0.30)兩倍。2、所有29名患者的責(zé)任斑塊處管壁重構(gòu)率(0.97±0.31)與非責(zé)任斑塊處管壁重構(gòu)率(1.08±0.29)沒有明顯差異(P=0.24)。但是責(zé)任斑塊組患者斑塊負(fù)荷明顯高于非責(zé)任斑塊組患者(P0.05)。結(jié)論:本研究發(fā)現(xiàn)ICAD患者斑塊顯著強(qiáng)化的這一特點(diǎn)可以用來發(fā)現(xiàn)缺血性腦血管事件患者的顱內(nèi)責(zé)任血管病灶;這一MR影像特點(diǎn)可能反應(yīng)斑塊炎癥和其內(nèi)大量新生血管并且有可能是顱內(nèi)不穩(wěn)定斑塊的標(biāo)志物,并且能夠?yàn)榛颊咴u(píng)估顱內(nèi)斑塊表現(xiàn)的是否為高風(fēng)險(xiǎn)斑塊,以及將來缺血性腦卒中發(fā)生的可能提供的一個(gè)比較深入的風(fēng)險(xiǎn)評(píng)估,從而可以讓患者從預(yù)防性干預(yù)治療獲益。
[Abstract]:Objective: To explore enhanced intracranial atherosclerotic plaque and the tube wall around the reconstruction patterns and new brain ischemic events are related, and then explore the intracranial atherosclerotic disease (Intracranial Atherosclerotic, Disease, ICAD) index in patients with intracranial atherosclerotic plaque imaging to guide clinical accurate assessment of intracranial arterial ICAD in patients with stable plaque, not on the intracranial intervention preventive patch, so as to reduce the incidence of cerebral infarction. Subjects and methods: in General Hospital Affiliated to Tianjin Medical University of intracranial atherosclerosis acute cerebral ischemic events in patients with 29 cases (24 cases, 5 cases of patients with acute ischemic stroke; TIA patients with 25 males, age range 41-80 years old, the average age of 61.7. At the age of 9.8). The specific inclusion and exclusion criteria are as follows: 1, through CTA, MRA or DSA found large intracranial artery stenosis; 2, intracranial arterial stenosis and cerebral The infarction or clinical symptoms of TIA blood DWI in the region; 3, to identify patients with intracranial large artery atherosclerotic stenosis belongs to type; 4, ipsilateral cranial exclusion of patients with cerebral ischemic symptoms of external carotid artery (extracranial internal carotid artery, EICA) stenosis greater than 50%; 5, the exclusion of other non atherosclerotic ischemic stroke type. All 29 patients were enrolled in the study in symptoms for plain and enhanced 3D (three dimensional-T1 weighted T1WI-SPACE four weeks imaging-sampling perfection with application optimized contrasts using different flip angle evolutions) and three dimensional time of flight (three dimensional time-of-flight, 3D TOF) MRA imaging. The first to rely on the plain and enhanced 3D T1WI-SPACE. 3D TOF MRA to locate the 29 patients of intracranial atherosclerotic plaque. Then, according to the DWI on the infarct location or patient TIA ischemic symptoms, all clear intracranial lesions were divided into plaque responsibility (cerebral ischemia area of feeding arteries or narrow vascular lesions) and non plaque group (not the responsibility vascular lesions in cerebral ischemic area in the feeding artery group); first of all according to plaque on enhanced 3D TIWI-SPACE sequence showed enhancement (grade 0 No, said the plaque strengthening; 1 level enhancement, the pituitary stalk signal strength; the degree of plaque enhancement is greater than 0 but the enhancement degree was significantly lower than that of normal reinforced 2 enhanced plaque enhancement in the normal approximation or strengthen the pituitary stalk signal strength) are classified and calculated the plaque enhancement rate; secondly, in order to measure intracranial artery stenosis plaque lumen area and position reference vessels (lumen area, LA), the vascular wall area (outer wall, area, OWA) and the calculated wall area (wall, area, WA); plaque burden for plaque at the most narrow WA and OWA Measurements of the ratio; wall reconstruction rate plaques (remodelling ratio, RR) to measure the plaque at the most narrow LA and the reference position of LA value ratio, reconstruction pattern classification based on: positive remodeling of RR1.05; the middle value of RR = 0.95 ~ 1.05; negative remodeling of RR0.95. results: 1,29 patients with acute cerebrovascular events patients found a total of 81 intracranial plaque, the plaque responsibility 29, non responsibility plaque 52. All 29 plaques were enhanced (1 level responsibility to strengthen the 38%, 2 grade 62%; strengthen the) all 52 non responsibility plaques, 21 plaques found only strengthened (Level 1 Level 2 to strengthen the 86%, strengthen 14%) after the qualitative analysis; all plaques, 0 plaques exist only to strengthen non responsibility plaque group, 2 strengthen and responsibility plaque has a certain relevance. Through quantitative analysis, strengthen the responsibility and liability rate of plaque plaque enhancement rate there was a significant difference (P0.001); responsibility (0.957 + 0.33 plaque enhancement rate a few) It is not the responsibility of plaque enhancement rate (0.429 + 0.30).2 two times, the wall reconstruction rate of liability plaques in all 29 patients (0.97 + 0.31) wall reconstruction rate and non responsibility plaque tube (1.08 + 0.29) there was no significant difference (P=0.24). But the responsibility of plaque group was significantly higher in patients with plaque load the responsibility of non plaque group patients (P0.05). Conclusion: This study found that the characteristics of plaque in patients with ICAD significantly enhanced intracranial vascular lesions can be used to find out the responsibility of ischemic cerebrovascular events in patients; the MR imaging features of plaque inflammation and its possible reaction within a large number of new vessels and may serve as a marker for intracranial atherosclerotic plaque. And for patients to assess intracranial plaque performance is a high risk of plaque and the occurrence of ischemic stroke in the future may provide a more in-depth risk assessment, which can make patients benefit from prophylactic pretreatment.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3;R445.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 B.C.Astor;R.Sharrett;J.Coresh;L.E.Chambless;B.A.Wasserman;龍淼淼;;頸動(dòng)脈重塑的MRI研究:動(dòng)脈粥樣硬化高危人群的頸動(dòng)脈MRI研究[J];國(guó)際醫(yī)學(xué)放射學(xué)雜志;2010年06期

2 ChimowitzM.I.;LynnM.J.;Howlett-Smith H.;黃衛(wèi)東;;華法林和阿司匹林治療癥狀性顱內(nèi)動(dòng)脈狹窄的比較研究[J];世界核心醫(yī)學(xué)期刊文摘(神經(jīng)病學(xué)分冊(cè));2005年09期

，

本文編號(hào)：1640625