發(fā)布時(shí)間：2018-06-23 04:06

  本文選題：急性腦梗死 + 高信號(hào)血管征　； 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:高信號(hào)血管征(hyperintense vessel sign,HVS)是缺血性腦血管病患者顱內(nèi)側(cè)支循環(huán)在磁共振液體衰減反轉(zhuǎn)恢復(fù)序列(fluid-attenuated inversion recovery,FLAIR)上的影像學(xué)表現(xiàn),其與局部腦血流灌注的關(guān)系尚不明確。本文以急性大腦中動(dòng)脈閉塞患者為研究對(duì)象,旨在探討HVS與局部腦血流灌注的相關(guān)性。方法:納入2015年10月至2016年12月期間于皖南醫(yī)學(xué)院弋磯山醫(yī)院神經(jīng)內(nèi)科住院治療的急性大腦中動(dòng)脈閉塞患者,共54例。所有患者需在入院后48小時(shí)內(nèi)行頭顱CT、頭顱磁共振成像(包括DWI序列和FLAIR序列)、頭顱磁共振血管成像(magetic resonace aniography,MRA)、CT灌注成像(CT perfusion,CTP)檢查。收集記錄患者一般臨床資料信息(包括性別、年齡、既往病史、入院時(shí)NIHSS評(píng)分、ASPECT評(píng)分等)、實(shí)驗(yàn)室檢查結(jié)果(包括血糖、血脂、血尿酸等)及影像學(xué)檢查結(jié)果(CT、MRI、MRA、CTP),并隨訪記錄患者30天改良的Rankin(modified Rankin Scale,mRS)評(píng)分。在MRI FLAIR序列上觀察HVS,并根據(jù)CTP獲取梗死側(cè)與健側(cè)鏡像區(qū)灌注參數(shù)值,包括腦血流量(cerebral blood flood,CBF)、腦血容量(cerebral blood volume,CBV)、達(dá)峰時(shí)間(time to peak,TTP)及平均通過(guò)時(shí)間(mean transit time,MTT),隨后用Spearman相關(guān)分析HVS分值和CTP各參數(shù)值之間的相關(guān)性。結(jié)果:(1)共入組54例大腦中動(dòng)脈閉塞患者,平均年齡62.19±13.53歲,其中男性36例(66.67%)、高血壓病36例(66.67%)、糖尿病17例(31.48%)、冠心病10例(18.52%)、吸煙18例(33.33%)、酗酒11例(20.37%)、大腦中動(dòng)脈閉塞區(qū)域HVS陽(yáng)性者共43例(79.63%)、HVS陰性者共11例(20.37%);(2)HVS陽(yáng)性組患者梗死側(cè)與健側(cè)鏡像區(qū)比較,CBF、CBV降低(t=-2.376,P=0.020;t=-2.980,P0.01),TTP延長(zhǎng)(t=4.537,P0.01),而MTT延長(zhǎng)無(wú)統(tǒng)計(jì)學(xué)意義(t=0.237,P0.05);HVS陰性組患者梗死側(cè)與健側(cè)鏡像區(qū)相比,CBF、CBV明顯降低(t=-4.043,P0.01;t=-3.996,P0.01),MTT及TTP均顯著延長(zhǎng)(t=2.194,P=0.040;t=2.182,P=0.044);(3)Spearman相關(guān)分析顯示,大腦中動(dòng)脈閉塞區(qū)域CBF、CBV值與HVS分值呈正相關(guān)(r=0.590,P0.01;r=0.502,P0.01),MTT與HVS分值呈負(fù)相關(guān)性(r=-0.329,P=0.015),TTP與HVS分值無(wú)相關(guān)性(r=-0.207,P=0.133);(4)HVS陽(yáng)性組患者入院NIHSS評(píng)分及30dmRS評(píng)分均低于HVS陰性組(t=2.895,P0.01;Z=-2.060,P=0.039),ASPECT評(píng)分高于HVS陰性組(Z=-2.024,P=0.043);(5)單因素分析顯示,兩組間糖尿病(?2=5.750,P=0.016)、血清總膽固醇(t=2.041,P=0.046)、甘油三酯(t=2.029,P=0.048)存在顯著差異;(6)多因素Logistic回歸分析顯示,糖尿病是影響大腦中動(dòng)脈閉塞患者HVS形成的獨(dú)立危險(xiǎn)因素(OR=4.758,95%CI1.053~21.502,P0.05)。結(jié)論:急性大腦中動(dòng)脈閉塞患者HVS的出現(xiàn)預(yù)示著缺血區(qū)域腦組織灌注良好,且患者預(yù)后較好。糖尿病是影響急性大腦中動(dòng)脈閉塞患者頭顱磁共振FLAIR序列HVS形成的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: high signal vascular sign (hyperintense vessel) is the imaging manifestation of intracranial collateral circulation in patients with ischemic cerebrovascular disease on fluid-attenuated inversion recovery sequence of fluid attenuated inversion (FLAIR), and its relationship with regional cerebral blood flow perfusion is not clear. The purpose of this study was to investigate the correlation between HVS and regional cerebral blood perfusion in patients with acute middle cerebral artery occlusion. Methods: from October 2015 to December 2016, 54 patients with acute middle cerebral artery occlusion (MCAO) were admitted to the Department of Neurology, Yiji Mountain Hospital, Southern Anhui Medical College. All patients should be performed CT perfusion imaging (CT perfusion imaging) within 48 hours after admission, head magnetic resonance imaging (including DWI sequence and flair sequence) and cranial magnetic resonance angiography (magetic resonace) perfusion imaging (CTP). Collect and record general clinical information (including gender, age, past medical history, NIHSS score on admission, ASPECT score, etc.), laboratory results (including blood sugar, blood lipid, etc.), Serum uric acid (UA) and imaging findings (CTN MRI MRACTP), and the modified Rankin scale score were recorded after 30 days follow-up. The HVS was observed on flair MRI sequence, and the perfusion parameters of the infarct side and the contralateral mirror region were obtained according to CTP. Including cerebral blood flow (cerebral blood), cerebral blood volume (cerebral blood), peak time (time to) and mean transit time (mean transit time). Then Spearman correlation was used to analyze the correlation between the scores of (cerebral blood and the parameters of (time to. Results: (1) 54 patients with middle cerebral artery occlusion (MCAO) were enrolled. The mean age was 62.19 鹵13.53 years old. Of them, 36 (66.67%) were male, 36 (66.67%) were hypertension, 17 (31.48%) were diabetes, 10 (18.52%) were coronary heart disease, 18 (33.33%) were smoking, 11 (20.37%) were alcoholism, 43 (79.63%) were HVS-negative in middle cerebral artery occlusion region, 11 (20.37%) were HVS-negative. The CBFCBV was significantly decreased in the CBFV negative group compared with that in the normal mirror region (tnr -2.376P0. 020t- 2.980m P0.01), but no significant difference was found in the prolongation of the CBV (t 2. 194 P0. 182 P0. 182 P0. 044); (3). The results of Spearman correlation analysis showed that the CBFCBV in the infarct side of the HVS-negative group was significantly lower than that in the normal mirror image region (t 4. 043 P0. 091 t-3) and the TTP was significantly prolonged (t 2. 194 P0. 040 t 2. 182P 0. 044); (3), the results showed that the CBFCBV in the infarct side of the HVS-negative group was significantly lower than that in the normal mirror image area (t = 4. 043, P = 0. 091, P < 0. 01). 澶ц剳涓姩鑴夐棴濉炲尯鍩烠BF,CBV鍊間笌HVS鍒嗗，

本文編號(hào)：2055689