本文選題：卒中　切入點(diǎn)：腦缺血　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】：(第一部分)酰胺質(zhì)子轉(zhuǎn)移成像在健康受試者及缺血性腦卒中患者的初步研究目的:酰胺質(zhì)子轉(zhuǎn)移加權(quán)(amide proton transfer-weighted,APTW)成像是一種新型的磁共振成像(magnetic resonance imaging,MRI)方法,可以對組織中pH進(jìn)行無創(chuàng)性評價(jià),先前動(dòng)物研究已經(jīng)證實(shí)其可以反映梗死后組織pH的變化。本研究目的是探討APTW成像在健康受試者及臨床缺血性腦卒中患者中的可行性。研究對象與方法:本研究納入30例受試者,包括確診急性期缺血性腦卒中(acute ischemic stroke)患者和健康受試者各15例,分別為卒中組和正常組。其中卒中組男性9例,女性6例,年齡界于44-83歲之間,平均年齡(65.2±13.2)歲;正常組男性8例,女性7例,年齡界于42-85歲之間,平均年齡(61.7±11.3)歲。所有受試者均行頭部常規(guī) T2 加權(quán)成像(T2-weighted imaging,T2WI)、擴(kuò)散加權(quán)成像(diffused-weighted imaging,DWI)、T1 加權(quán)成像(T1-weighted imaging,T1WI)以及APTW成像,卒中組測量病變區(qū)及對側(cè)正常腦白質(zhì)區(qū)的酰胺質(zhì)子不對稱磁化轉(zhuǎn)移率(MTRasym),即APTW效應(yīng)值的變化,正常組選擇基底節(jié)層面測量其兩側(cè)顳葉正常腦白質(zhì)區(qū)的APTW值。采用配對t檢驗(yàn)方法檢測組內(nèi)兩側(cè)腦區(qū)APTW值的差異,組間差異采用方差分析方法進(jìn)行評估。結(jié)果:卒中組病變區(qū)APTW效應(yīng)值較對側(cè)正常腦區(qū)明顯減低(P0.001),患側(cè)與對側(cè)的APTW值分別為(-0.67±0.27)%和(0.12±0.08)%。對照組兩側(cè)腦白質(zhì)區(qū)的APTW值分別(0.13±0.03)%和(0.14±0.06)%,兩側(cè)之間無明顯差異。卒中組對側(cè)正常腦白質(zhì)區(qū)與正常組兩側(cè)腦白質(zhì)區(qū)之間APTW值無顯著性差異。結(jié)論:作為一種無創(chuàng)無輻射的磁共振成像方法,APT成像可以檢測出急性腦缺血病變的存在,對臨床診治具有一定的潛在應(yīng)用價(jià)值。(第二部分)酰胺質(zhì)子轉(zhuǎn)移成像在評估不同時(shí)期缺血性腦卒中的初步應(yīng)用目的:缺血性腦卒中是臨床常見病及高發(fā)病,明確腦卒中病變的演變對臨床診治具有一定的價(jià)值。已經(jīng)證實(shí)酰胺質(zhì)子轉(zhuǎn)移加權(quán)(amide proton transfer-weighted,APTW)成像可以對組織中pH變化進(jìn)行無創(chuàng)性評價(jià),其在反映腦梗死組織pH變化方面具有較好的應(yīng)用前景。本研究目的是探討APTW成像在評估缺血性腦卒中病變演變中的應(yīng)用價(jià)值。研究對象與方法:本研究納入我院2014年到2016年期間經(jīng)臨床及影像學(xué)檢查確診的缺血性腦卒中患者39例,其中男性23例,女16例,年齡界于26-90歲之間,平均年齡(62.7±14.3)歲,發(fā)病時(shí)間界于2小時(shí)至7天之間。根據(jù)其發(fā)病時(shí)間的不同將其分為四期:超急性期患者4例(發(fā)病時(shí)間≤6小時(shí)),急性期患者18例(6小時(shí)發(fā)病時(shí)間≤48小時(shí)),亞急性早期患者10例(48小時(shí)發(fā)病時(shí)間≤96小時(shí)),亞急性晚期患者7例(96小時(shí)發(fā)病時(shí)間≤168小時(shí))。各期患者均進(jìn)行APTW成像及常規(guī)MR成像,包括T2加權(quán)成像(T2-weighted imaging,T2WI)、擴(kuò)散加權(quán)成像(diffused-weightedimaging,DWI)、T1 加權(quán)成像(T1-weightedimaging,T1WI)。APTW成像選擇DWI顯示病變最大面積層面進(jìn)行橫斷位成像,對APTW圖像進(jìn)行酰胺質(zhì)子(約3.5ppm處)不對稱磁化轉(zhuǎn)移率的分析,進(jìn)而獲得APTW效應(yīng)值。結(jié)果:在各期患者中,與對側(cè)正常腦白質(zhì)區(qū)比較,梗死區(qū)APTW信號值均顯示出了明顯減低(P0.05)。各期患者梗死區(qū)APTWave值依次分別為(-0.85±0.02)%、(-0.64±0.09)%、(-0.48±0.11)%及(-0.34±0.10)%,APTWmax 值分別為(-0.02±0.04)%、(-0.24±0.07)%、(-0.23±0.10)%及(-0.11±0.07)%,APTWmin值分別為(-1.24±0.04)%、(-1.06±0.10)%、(-0.85±0.08)%及(-0.70±0.09)%,APTWmax-min值分別為(1.22±0.06)%、(0.82±0.07)%、(0.62±0.05)%及(0.59±0.07)%。與其他各期患者相比,超急性期患者APTWave及APTWmin相比其他各組降低,APTWmax-min顯著高于其他各期�；貧w分析顯示,APTWave與APTWmin與發(fā)病時(shí)間之間均存在一定的正相關(guān)性。APTWmax-min隨著發(fā)病時(shí)間延長有降低的趨勢(R2 = 0.44,P0.001)。結(jié)論:缺血性腦卒中后腦內(nèi)梗死區(qū)相比于對側(cè)正常腦白質(zhì)區(qū)存在持續(xù)性的組織內(nèi)pH的降低,即組織酸中毒的存在,隨著發(fā)病時(shí)間的增加,這種組織中酸性環(huán)境有所緩解。APTW成像可以一定程度上反映腦卒中組織在不同時(shí)期及時(shí)間點(diǎn)的pH加權(quán)特性。(第三部分)酰胺質(zhì)子轉(zhuǎn)移成像在缺血性腦卒中患者中的回顧分析目的:酰胺質(zhì)子轉(zhuǎn)移(amide proton transfer,APT)加權(quán)磁共振成像(magnetic resonance imaging,MRI)在腦卒中患者中已經(jīng)證實(shí)具有較好的應(yīng)用價(jià)值。但其在不同類型缺血性腦卒中的APT影像表現(xiàn)特征尚無研究探討。本研究擬探討不同類型急性缺血性腦卒中(acute ischemic stroke,AIS)患者的APT加權(quán)(APT-weighted,APTW)成像特點(diǎn)。研究對象與方法:納入81例起病在96h以內(nèi)的AIS患者,其中男性56例,女性25例,年齡界于26-92歲之間,平均年齡(65.5± 13.7)歲。所有受試者均行APTW及常規(guī)MR成像檢查,其中常規(guī)MR成像包括擴(kuò)散加權(quán)成像(diffusion weighted imaging,DWI)、T2WI 及 T1WI。按照牛津郡社區(qū)腦卒中規(guī)劃(Oxfordshire Community Stroke Project,OCSP)影像學(xué)分型,將其分為4種類型:完全前循環(huán)梗死(total anterior circulation infarcts,TACI)患者9例,部分前循環(huán)梗死(partial anterior circulation infarcts,PACI)患者28例,腔隙性腦梗死(lacunar circulation infarcts,LACI)患者33例,后循環(huán)梗死(posterior circulation infarcts,POCI)患者15例。分別測量各期梗死區(qū)APTW信號值(APTWlesion)以及對側(cè)正常腦區(qū)APTW信號值(APTWcon),并且計(jì)算二者之間的差值A(chǔ)PTWles-con。應(yīng)用SPSS軟件對各組結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:TACI組、PACI組及POCI組APTWlesion和APTWcon之間存在明顯的差異(P0.01),但LACI組兩者之間無明顯差異(P=0.080)。與其他各組比較,LACI組有較高APTWlession和較低的APTWles-con(P均0.01);TACI組患者APTWlesion低于其他組,APTWles-con高于其他組(P均0.01)。腦干梗死患者梗死區(qū)及對側(cè)正常腦區(qū)之間APTWlesion和APTWcon無明顯差異。結(jié)論:TACI組患者梗死區(qū)存在較為嚴(yán)重的組織酸中毒,LACI組梗死區(qū)組織酸中毒較輕。APTW MRI能夠檢測到TACI及PACI組患者梗死灶和病變區(qū)組織酸中毒的存在。但是,對于LACI及腦干梗死患者,APTW成像效果欠佳。
[Abstract]:(the first part) amide proton transfer imaging in healthy subjects and patients with ischemic stroke Objective: preliminary study of amide proton transfer (amide proton transfer-weighted, APTW weighted imaging) is a kind of new type of magnetic resonance imaging (magnetic resonance, imaging, MRI) method, can pH in the noninvasive evaluation, previously animal studies have confirmed that it can reflect the change of pH after infarction. The purpose of this study is to explore the APTW imaging in healthy subjects and patients with the clinical feasibility of ischemic cerebral stroke. Subjects and methods: the study included 30 subjects, including the diagnosis of acute ischemic stroke (acute ischemic stroke) patients and healthy subjects 15 cases respectively, stroke group and normal group. 9 cases of stroke in males, 6 females, aged 44-83 years old, the average age (65.2 + 13.2) years; 8 cases of normal male group, 7 cases were female, aged 42-85 years old, the average age (61.7 + 11.3) years old. All subjects were performed conventional T2 weighted imaging (T2-weighted imaging, T2WI), diffusion weighted imaging (diffused-weighted imaging, DWI), T1 (T1-weighted imaging, T1WI weighted imaging) and APTW imaging, amide proton asymmetry magnetization measurement stroke lesions and contralateral normal brain white matter transfer rate (MTRasym), the change of APTW value effect, normal group level measurement of basal ganglia on both sides of the temporal lobe of normal brain white matter APTW values. The difference by paired t test method for detection of group APTW value on both sides of the brain. The variance analysis method was employed to assess the differences between the groups. Results: the stroke group APTW lesion effect value than that of the normal brain area was significantly decreased (P0.001), ipsilateral and contralateral APTW = (-0.67 + 0.27)% and (0.12 + 0.08)%. The control group on both sides of the brain white matter APT The values of W were (0.13 + 0.03)% and (0.14 + 0.06)%, no significant difference between both sides. Between APTW and contralateral normal white matter stroke group and the control group on both sides of the brain white matter was no significant difference. Conclusion: as a noninvasive magnetic resonance imaging method without radiation, APT imaging can detect acute cerebral ischemia lesion, have certain potential application value for clinical diagnosis and treatment. (part second) amide proton transfer imaging in the evaluation of different periods of ischemic stroke application Objective: ischemic stroke is a common clinical disease and high incidence of stroke lesions clearly, evolution has certain clinical value in the diagnosis and treatment has been confirmed. Amide proton transfer (amide proton transfer-weighted, APTW weighted imaging) can the organization of pH changes for noninvasive evaluation, and has good application prospects in the pH reflect the changes of cerebral infarction tissue. The purpose of this study The application value of APTW imaging in assessment of ischemic stroke lesions in the evolution. Subjects and methods: This study included in our hospital during 2014 to 2016 by clinical and imaging examination in patients with ischemic stroke in 39 cases, including 23 cases of male, female 16 cases, aged 26-90 years old, the average age of (62.7 + 14.3) years old, the onset time from 2 hours to 7 days. According to the onset time divided into four period: 4 cases of patients with hyperacute (onset within 6 hours), 18 cases of patients with acute (48 hours and 6 hours of onset time less than), early subacute patients 10 cases (48 hours of onset within 96 hours), 7 patients with subacute stage (96 hours of onset within 168 hours). The patients underwent APTW imaging and conventional MR imaging, including T2 weighted imaging (T2-weighted imaging, T2WI), diffusion weighted imaging (diffused-weightedimaging, DWI), T1 鍔犳潈鎴愬儚(T1-weightedimaging,T1WI).APTW鎴愬儚閫夋嫨DWI鏄劇ず鐥呭彉鏈，

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