本文關(guān)鍵詞： 頸內(nèi)動脈 動脈粥樣硬化 腦梗塞 梗塞模式 發(fā)病機制 彌散加權(quán)成像　出處：《天津醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過運用MRI彌散加權(quán)成像序列(diffusion weighted imaging,DWI)、MR血管成像(magnetic resonance angiography,MRA)、CT血管成像(computed tomo-graphy angiography,CTA)等影像學(xué)方法,分析頸內(nèi)動脈系統(tǒng)動脈粥樣硬化重度狹窄或閉塞的急性腦梗塞患者梗塞灶分布模式,探索各血管重度狹窄或閉塞所致腦梗塞的主要發(fā)病機制,從而指導(dǎo)臨床對腦梗塞患者制定早期治療及預(yù)防復(fù)發(fā)的策略,以及對頸內(nèi)動脈系統(tǒng)動脈粥樣硬化性狹窄的患者提前給予干預(yù)治療,預(yù)防腦梗塞的發(fā)生。對象與方法:收集2015-2016年天津醫(yī)科大學(xué)總醫(yī)院116例急性腦梗塞患者,滿足以下標(biāo)準(zhǔn):1、發(fā)病一周內(nèi)行DWI序列掃描,可見急性腦梗塞灶;2、急性梗塞灶位于單側(cè)頸內(nèi)動脈系統(tǒng)供血區(qū);3、梗塞灶是同側(cè)大腦前動脈(anterior cerebral artery,ACA)、大腦中動脈(middle cerebral artery,MCA)、頸內(nèi)動脈顱內(nèi)段(intracranial internal carotid artery,IICA)或頸內(nèi)動脈顱外段(extracranial internal carotid artery,EICA)血管動脈粥樣硬化重度狹窄(狹窄程度≥70%)或閉塞引起;4、排除其他導(dǎo)致腦梗塞的病因。按照血管狹窄或閉塞的部位將116例患者分為四組:ACA病變組、MCA病變組、IICA病變組、EICA病變組。使用被公認(rèn)的大腦動脈供血區(qū)模板識別梗塞灶的分布,將顱腦血管供血區(qū)域劃分為穿支動脈供血區(qū)、皮質(zhì)支血管供血區(qū)和分水嶺區(qū)。按照頸內(nèi)動脈系統(tǒng)供血區(qū)梗塞病灶在DWI上的分布,將DWI梗塞模式細(xì)分為:1、單一模式:(1)穿支動脈供血區(qū)梗塞(perforating artery infarct,PAI);(2)皮質(zhì)支供血區(qū)梗塞(pial artery infarct,PI);(3)分水嶺區(qū)梗塞(border-zone infarct,BZI);(4)大面積區(qū)域性梗塞(large territorial infarct);2、混合模式:(5)PI+PAI;(6)PI+BZI;(7)PAI+BZI;(8)PI+PAI+BZI。結(jié)果:1、ACA病變組患者15例,男11例,女4例。ACA重度狹窄或閉塞部位最常見于A2段(80%)。DWI梗塞模式以單一模式(73.3%)多見。所有DWI梗塞模式中,以大面積區(qū)域性梗塞(40%)最多見。2、MCA病變組患者60例,男38例,女22例。MCA重度狹窄或閉塞部位最常見于M1段(95%)。DWI梗塞模式以混合模式(63.3%)多見。所有DWI梗塞模式中,以PI+BZI模式(35%)最多見。3、IICA病變組患者18例,男14例,女4例。IICA重度狹窄或閉塞部位最常見于海綿竇段(66.7%)。DWI梗塞模式中,單一模式與混合模式均為9例(50%)。所有梗塞模式中,BZI單一模式7例(38.9%),PI和/或PAI模式2例(11.1%),BZ合并PI和/或PAI模式共存9例(50%)。4、EICA病變組患者23例,男18例,女5例。EICA重度狹窄或閉塞部位最常見于頸動脈竇處21例(91.3%)。DWI梗塞模式以混合模式(60.9%)多見。所有模式中,BZI模式6例(26.1%),PI和/或PAI模式4例(17.4%),BZI合并PI和/或PAI模式13例(56.5%)。結(jié)論:ACA粥樣硬化性重度狹窄或閉塞最常見的梗塞模式為大面積區(qū)域性梗塞,原位血栓栓塞為最主要的發(fā)病機制。MCA粥樣硬化性重度狹窄或閉塞最常見的梗塞模式為PI+BZI,動脈-動脈栓塞合并血液動力學(xué)所致低灌注為最主要的發(fā)病機制。IICA與EICA粥樣硬化性重度狹窄或閉塞最常見的梗塞模式均為BZI與PI和/或PAI共存的梗塞模式,動脈-動脈栓塞合并血液動力學(xué)所致低灌注為最主要的發(fā)病機制。
[Abstract]:Objective: through the use of MRI diffusion weighted imaging sequence (diffusion weighted imaging, DWI), MR angiography (magnetic resonance angiography, MRA), CT angiography (computed Tomo-graphy angiography, CTA) and other imaging methods, analysis of severe stenosis or occlusion of coronary atherosclerosis in patients with acute cerebral infarction infarction of internal carotid artery system dynamic distribution pattern and to explore the main pathogenesis of cerebral infarction with severe stenosis or occlusion of the blood vessels, so as to guide the clinical in patients with cerebral infarction for early treatment and relapse prevention strategies, and for patients with atherosclerotic stenosis of internal carotid artery system early intervention, prevention of cerebral infarction. Subjects and methods: collected 116 cases of acute 2015-2016 years in General Hospital Affiliated to Tianjin Medical University in patients with cerebral infarction, to meet the following criteria: 1, the incidence of DWI within one week of sequence scan, seen with acute cerebral infarct; 2, acute Infarct foci in unilateral internal carotid artery system; 3, the infarct is the ipsilateral anterior cerebral artery (anterior cerebral, artery, ACA), middle cerebral artery (middle cerebral, artery, MCA), intracranial segment of internal carotid artery (intracranial internal carotid artery, IICA) or extracranial internal carotid artery (extracranial internal carotid artery. EICA) atherosclerosis stenosis (more than 70% stenosis or occlusion caused; 4), exclusion of other causes of cerebral infarction. According to the location of vascular stenosis or occlusion 116 cases were divided into four groups: ACA lesion group, MCA lesion group, IICA lesion group, EICA lesion group. Brain artery pattern recognition the infarcts distribution using a recognized, the brain blood supply area into perforator artery area, cortical vessel supply area and watershed area. According to the system of internal carotid artery supply area infarction lesions on DWI 鍒嗗竷,灝咲WI姊楀妯″紡緇嗗垎涓，

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