利用高分辨管壁成像探索大腦中動(dòng)脈斑塊特性及其臨床意義
發(fā)布時(shí)間：2018-07-31 16:25
【摘要】：背景：顱內(nèi)動(dòng)脈粥樣硬化(Intracranial atherosclerotic disease, ICAD)是亞洲人群卒中的首要病因。高分辨管壁成像(High resolution vessel wall imaging, HRVWI)可無(wú)創(chuàng)地觀察顱內(nèi)血管壁、管腔、斑塊形態(tài)和斑塊內(nèi)成分,在判斷ICAD患者斑塊易損性、預(yù)測(cè)臨床預(yù)后方面具有很大的潛力。目的：利用HRVWI探索ICAD患者梗死類型、大腦中動(dòng)脈(Middle cerebral artery, MCA)狹窄程度與斑塊、管壁及重塑特點(diǎn)間的相關(guān)性,以闡明ICAD患者卒中的病理生理機(jī)制。方法：本研究回顧性分析2009至2015年于北京協(xié)和醫(yī)院連續(xù)收集的缺血性腦卒中患者和既往無(wú)卒中病史的患者。癥狀組的納入標(biāo)準(zhǔn)包括發(fā)病時(shí)間≤2周的MCA供血區(qū)梗死,以及HRVWI上患側(cè)MCA M1段的偏心性斑塊。無(wú)癥狀組的納入標(biāo)準(zhǔn)包括既往無(wú)卒中病史和HRVWI上MCA M1段的偏心性斑塊。根據(jù)癥狀組患者梗死類型,分為穿支梗死組、栓塞性梗死組和孤立的白質(zhì)區(qū)梗死組(不納入下一步分析)。在HRVWI上測(cè)量MCA M1段最狹窄層面的管腔面積、血管外圍面積、斑塊分布(斑塊累及上、下、前、后四個(gè)象限)、斑塊長(zhǎng)度、斑塊厚度、斑塊信號(hào)和斑塊表面不連續(xù)等影像學(xué)標(biāo)記物,選取相對(duì)正常的血管橫斷面作為參照點(diǎn),測(cè)量參照點(diǎn)管腔面積和參照點(diǎn)外圍面積。計(jì)算斑塊指數(shù)(斑塊累及象限數(shù)之和)、管壁面積、狹窄率和重塑率。將穿支梗死組及栓塞性梗死組的影像學(xué)標(biāo)記物分別與無(wú)癥狀組進(jìn)行單因素分析和logistic回歸分析。結(jié)果：共納入患者232例,其中癥狀組113例,無(wú)癥狀組119例。癥狀組中,穿支梗死組54例,栓塞性梗死組52例。三組中狹窄率與斑塊長(zhǎng)度、厚度和斑塊指數(shù)顯著相關(guān)(p0.05)。穿支梗死組和無(wú)癥狀組中,狹窄率與縮窄性重塑顯著相關(guān)(p0.05)。栓塞性梗死組和無(wú)癥狀組中,管壁面積與狹窄率顯著相關(guān)(p0.05)。單因素分析提示,與無(wú)癥狀組相比,穿支梗死組的斑塊累及下壁、前壁和后壁更少(p0.05),最厚點(diǎn)位于上壁的斑塊更多(p0.05),管腔面積更大(p0.001),斑塊指數(shù)更低(p0.001)。二元logistic回歸分析顯示,斑塊最厚點(diǎn)位于上壁(p=0.003, OR 3.158,95%CI 1.490-6.690),管腔面積(p=0.005, OR 1.315, 95%CI 1.089-1.589)和斑塊指數(shù)(p=0.010, OR 0.575,95%CI 0.378-0.874)是穿支梗死組的獨(dú)立預(yù)測(cè)因素。與無(wú)癥狀組相比,栓塞性梗死組的斑塊累及前壁和后壁更多(p0.05),斑塊長(zhǎng)度、厚度更大(p0.001),信號(hào)混雜和表面不連續(xù)的斑塊更多(p0.05),狹窄率更大(p0.001),更多擴(kuò)張性重塑(p0.01),管壁面積更大(p0.001),管腔面積更小(p0.01),斑塊指數(shù)更大(p0.01)。二元logistic回歸分析顯示狹窄率(p=0.008, OR 9.996,95%CI 2.141-46.665)、斑塊長(zhǎng)度(p=0.003, OR 1.295,95%CI 1.068-1.569)和擴(kuò)張性重塑(p=0.002, OR 3.785, 95%CI 1.601-8.947)是栓塞性梗死的獨(dú)立預(yù)測(cè)因素。在輕度狹窄組中,栓塞性梗死有更多斑塊表面不連續(xù)和擴(kuò)張性重塑(p0.05),且斑塊表面不連續(xù)為栓塞性梗死的唯一獨(dú)立預(yù)測(cè)因素(p=0.016, OR 5.146,95%CI 1.354-19.533)。結(jié)論：1)不同梗死類型與無(wú)癥狀組之間,隨狹窄率升高,管壁面積的變化和重塑類型不同。2)與無(wú)癥狀組相比較,穿支梗死組的獨(dú)立預(yù)測(cè)因素包括最厚點(diǎn)位于上壁的斑塊,斑塊指數(shù)和管腔面積,提示最厚點(diǎn)位于上壁的斑塊是一種特殊類型的高危板塊；邊緣累及上壁的斑塊不易發(fā)生穿支梗死；血管的普遍重塑可能在不同卒中機(jī)制中起到一定作用。3)栓塞性梗死組的獨(dú)立預(yù)測(cè)因素為狹窄率、斑塊長(zhǎng)度和擴(kuò)張性重塑;其中管腔輕度狹窄的患者中,斑塊表面不連續(xù)是栓塞性梗死的獨(dú)立預(yù)測(cè)因素,提示斑塊破裂所致的栓塞性梗死可能是輕度ICAD患者的重要卒中機(jī)制,可用于隱源性卒中的病因分析。
[Abstract]:Background: Intracranial atherosclerotic disease (ICAD) is the leading cause of stroke in Asian population. High resolution tube wall imaging (High resolution vessel wall imaging, HRVWI) can noninvasive observation of intracranial vascular wall, lumen, plaque morphology and intrapular components. It can predict plaque vulnerability in ICAD patients and predict clinical symptoms. The prognosis has great potential. Objective: To explore the correlation between the infarct type, the degree of Middle cerebral artery (MCA), the degree of Middle cerebral artery (MCA) and the characteristics of the wall and remodeling of the Middle cerebral artery, in order to clarify the pathophysiological mechanism of the stroke in ICAD patients. Methods: a retrospective analysis of the Beijing Concorde doctors from 2009 to 2015 in this study. A hospital continuous collection of ischemic stroke patients and patients who had no history of stroke in the past. The inclusion criteria of the symptom group included the MCA blood supply area infarction at the onset of 2 weeks and the eccentricity plaque on the MCA M1 segment on the side of the HRVWI. The inclusion criteria of the asymptomatic group included the past history of stroke and the eccentricity of the MCA M1 segment on HRVWI. Patients with infarct type were divided into perforator infarction group, embolic infarction group and isolated white matter area infarction group (not included in the next step analysis). On the HRVWI, the narrowest layer of lumen area, peripheral area of blood vessel, plaque distribution (plaque involvement, lower, four quadrants), plaque length, plaque thickness, plaque signal and plaque were measured on the MCA M1 segment. Surface discontinuity and other imaging markers were used to select the relative normal vascular cross sections as reference points, to measure the area of the lumen and the peripheral area of the reference point at the reference point. The plaque index (the sum of the plaques involving the quadrant), the area of the tube wall, the stenosis rate and the remolding rate were calculated. The imaging markers of the perforating and embolic infarction groups were separately and asymptomatic. Results: single factor analysis and logistic regression analysis. Results: 232 cases were included in the patients, including 113 symptomatic and 119 asymptomatic groups, 54 in the perforating infarction group and 52 in the embolic infarction group in the symptom group. The stenosis rate in the three groups was significantly correlated with the plaque length, thickness and plaque index (P0.05). The stenosis rate in the perforator infarction group and the asymptomatic group. There was a significant correlation with constrictive remodeling (P0.05). The area of the tube wall was significantly correlated with the rate of stenosis in the embolic and asymptomatic groups (P0.05). Single factor analysis suggested that the plaque involved the lower wall, the anterior wall and the posterior wall (P0.05), the thicker (P0.05) and greater lumen area (p0.001) in the perforating infarction group than in the asymptomatic group. The plaque index was lower (p0.001). The two yuan logistic regression analysis showed that the thickest spot was in the upper wall (p=0.003, OR 3.158,95%CI 1.490-6.690). The lumen area (p=0.005, OR 1.315, 95%CI 1.089-1.589) and plaque index (p=0.010, OR) were independent predictors of the perforating infarction. Compared with the asymptomatic group, embolic sex The plaque in the infarct group involved the anterior and posterior walls more (P0.05), the plaque length and the thickness (p0.001), the signal confounding and the surface discontinuous patches were more (P0.05), the stenosis rate was greater (p0.001), more dilated remodeling (P0.01), the wall area was larger (p0.001), the lumen area was smaller (P0.01), the plaque index was larger (P0.01). Two yuan logistic regression analysis The stenosis rate (p=0.008, OR 9.996,95%CI 2.141-46.665), plaque length (p=0.003, OR 1.295,95%CI 1.068-1.569) and dilated remodeling (p=0.002, OR 3.785, 95%CI 1.601-8.947) were independent predictors of infarct infarction. In the mild stenosis group, embolic infarction had more plaque surface discontinuity and dilated remodeling. Block surface discontinuity was the only independent predictor of embolic infarction (p=0.016, OR 5.146,95%CI 1.354-19.533). Conclusion: 1) the independent predictors of perforating infarction include the thickest point in the perforating infarction group compared with the asymptomatic group, with the increase of the stenosis rate, the change in the area of the tube wall, and the different type of remodeling type between the asymptomatic group and the asymptomatic group. The plaque, plaque index, and lumen area of the upper wall suggest that the thickest plaque at the upper wall is a special type of high risk plate; the plaque with the edge and the upper wall is not susceptible to perforating infarction; the general remodeling of the blood vessels may play a role in different stroke mechanisms.3) the independent predictor of the thrombus stopper infarction is the narrowing rate. Plaque length and dilatation remodeling; in patients with mild stenosis, plaque surface discontinuity is an independent predictor of embolic infarction, suggesting that embolic infarction caused by plaque rupture may be an important stroke mechanism in mild ICAD patients and can be used to analyze the etiology of cryptogenic stroke.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R743
本文編號(hào)：2156143
[Abstract]:Background: Intracranial atherosclerotic disease (ICAD) is the leading cause of stroke in Asian population. High resolution tube wall imaging (High resolution vessel wall imaging, HRVWI) can noninvasive observation of intracranial vascular wall, lumen, plaque morphology and intrapular components. It can predict plaque vulnerability in ICAD patients and predict clinical symptoms. The prognosis has great potential. Objective: To explore the correlation between the infarct type, the degree of Middle cerebral artery (MCA), the degree of Middle cerebral artery (MCA) and the characteristics of the wall and remodeling of the Middle cerebral artery, in order to clarify the pathophysiological mechanism of the stroke in ICAD patients. Methods: a retrospective analysis of the Beijing Concorde doctors from 2009 to 2015 in this study. A hospital continuous collection of ischemic stroke patients and patients who had no history of stroke in the past. The inclusion criteria of the symptom group included the MCA blood supply area infarction at the onset of 2 weeks and the eccentricity plaque on the MCA M1 segment on the side of the HRVWI. The inclusion criteria of the asymptomatic group included the past history of stroke and the eccentricity of the MCA M1 segment on HRVWI. Patients with infarct type were divided into perforator infarction group, embolic infarction group and isolated white matter area infarction group (not included in the next step analysis). On the HRVWI, the narrowest layer of lumen area, peripheral area of blood vessel, plaque distribution (plaque involvement, lower, four quadrants), plaque length, plaque thickness, plaque signal and plaque were measured on the MCA M1 segment. Surface discontinuity and other imaging markers were used to select the relative normal vascular cross sections as reference points, to measure the area of the lumen and the peripheral area of the reference point at the reference point. The plaque index (the sum of the plaques involving the quadrant), the area of the tube wall, the stenosis rate and the remolding rate were calculated. The imaging markers of the perforating and embolic infarction groups were separately and asymptomatic. Results: single factor analysis and logistic regression analysis. Results: 232 cases were included in the patients, including 113 symptomatic and 119 asymptomatic groups, 54 in the perforating infarction group and 52 in the embolic infarction group in the symptom group. The stenosis rate in the three groups was significantly correlated with the plaque length, thickness and plaque index (P0.05). The stenosis rate in the perforator infarction group and the asymptomatic group. There was a significant correlation with constrictive remodeling (P0.05). The area of the tube wall was significantly correlated with the rate of stenosis in the embolic and asymptomatic groups (P0.05). Single factor analysis suggested that the plaque involved the lower wall, the anterior wall and the posterior wall (P0.05), the thicker (P0.05) and greater lumen area (p0.001) in the perforating infarction group than in the asymptomatic group. The plaque index was lower (p0.001). The two yuan logistic regression analysis showed that the thickest spot was in the upper wall (p=0.003, OR 3.158,95%CI 1.490-6.690). The lumen area (p=0.005, OR 1.315, 95%CI 1.089-1.589) and plaque index (p=0.010, OR) were independent predictors of the perforating infarction. Compared with the asymptomatic group, embolic sex The plaque in the infarct group involved the anterior and posterior walls more (P0.05), the plaque length and the thickness (p0.001), the signal confounding and the surface discontinuous patches were more (P0.05), the stenosis rate was greater (p0.001), more dilated remodeling (P0.01), the wall area was larger (p0.001), the lumen area was smaller (P0.01), the plaque index was larger (P0.01). Two yuan logistic regression analysis The stenosis rate (p=0.008, OR 9.996,95%CI 2.141-46.665), plaque length (p=0.003, OR 1.295,95%CI 1.068-1.569) and dilated remodeling (p=0.002, OR 3.785, 95%CI 1.601-8.947) were independent predictors of infarct infarction. In the mild stenosis group, embolic infarction had more plaque surface discontinuity and dilated remodeling. Block surface discontinuity was the only independent predictor of embolic infarction (p=0.016, OR 5.146,95%CI 1.354-19.533). Conclusion: 1) the independent predictors of perforating infarction include the thickest point in the perforating infarction group compared with the asymptomatic group, with the increase of the stenosis rate, the change in the area of the tube wall, and the different type of remodeling type between the asymptomatic group and the asymptomatic group. The plaque, plaque index, and lumen area of the upper wall suggest that the thickest plaque at the upper wall is a special type of high risk plate; the plaque with the edge and the upper wall is not susceptible to perforating infarction; the general remodeling of the blood vessels may play a role in different stroke mechanisms.3) the independent predictor of the thrombus stopper infarction is the narrowing rate. Plaque length and dilatation remodeling; in patients with mild stenosis, plaque surface discontinuity is an independent predictor of embolic infarction, suggesting that embolic infarction caused by plaque rupture may be an important stroke mechanism in mild ICAD patients and can be used to analyze the etiology of cryptogenic stroke.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R743
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