本文選題：磁共振成像　切入點：頸動脈疾病　出處：《中國人民解放軍醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:應(yīng)用頸動脈高分辨率磁共振成像技術(shù),探討斑塊內(nèi)出血(intraplaque hemorrhage, IPH )與斑塊穩(wěn)定性之間的相關(guān)性。材料和方法:1.探討雙側(cè)斑塊內(nèi)IPH與斑塊穩(wěn)定性的關(guān)系:回顧性分析2009年12月至2012年12月間來我院行頸動脈高分辨磁共振檢查的患者,納入有IPH的患者44例,將患者按單、雙側(cè)IPH分為兩組,單側(cè)組30例,雙側(cè)組14例。采用Wilcoxon秩和檢驗、卡方檢驗、Logistic回歸分析對兩組間的纖維帽狀態(tài),斑塊易損性及年齡差異進行分析。2.探索IPH出血時期及出血體積與纖維帽破裂(fibrous cap rupture, FCR)之間的相關(guān)性:回顧性分析2009年12月至2012年12月間來我院行頸動脈高分辨磁共振檢查的患者,納入有IPH的患者37例,斑塊41個。將斑塊分為FCR組及無FCR組,FCR組有27例,無FCR組14例。計算FCR的發(fā)生率并且測量患者的新鮮出血、近期出血、全部出血的體積。利用Wilcoxon秩和檢驗、卡方檢驗、相關(guān)性檢驗及Logistic回歸分析對各時期出血的體積與FCR的相關(guān)性進行分析。結(jié)果:1.雙側(cè)IPH組患者的年齡小于單側(cè)IPH組患者(66.62±9.36歲vs. 73.70±9.06歲,P=0.027 );另外雙側(cè)IPH組患者斑塊最大斑塊厚度(6.34±1.93mm vs. 5.05±1.25mm,P=0.035 )和潰瘍的發(fā)生率(50%vs. 13.3%,P=0.025)明顯高于單側(cè)IPH組患者。Logistic回歸分析發(fā)現(xiàn),雙側(cè)IPH與潰瘍的發(fā)生具有明顯的相關(guān)性(OR=6.50,95%CI 1.47-28.70,P=0.014),模型1校正性別后,兩者仍具有顯著相關(guān)性(OR=5.71,95%CI 1.12-29.21,P=0.036)。然而,模型2中額外校正年齡(P=0.131)或最大斑塊厚度(P=0.139)后,雙側(cè)IPH與潰瘍的發(fā)生不具有顯著相關(guān)性。2.存在FCR的斑塊,其新鮮出血的體積明顯大于無FCR的斑塊(109.83±75.49 mm3 vs.30.54±20.62 mm3,P=0.002)。Logogisc回歸分析出血體積與FCR之間的相關(guān)性,新鮮出血的體積OR值為1.74 (95% CI,1.13-2.67, P=0.012),而近期出血的體積OR值為1.36 (95%CI, 0.84-2.18,P=0.208)。矯正了各類影響因素后,新鮮出血的體積及近期出血的體積的OR值分別為1.78 (95%CI,1.12-2.82, P=0.015)及1.43(95%CI, 0.86-2.38, P=0.172)。ROC曲線分析顯示,新鮮出血體積的AUC明顯大于近期出血體積(AUC: 0.79 vs. 0.64)。結(jié)論:1.與單側(cè)IPH患者相比,雙側(cè)IPH患者的年齡較輕、斑塊負(fù)荷更重、潰瘍發(fā)生率更高。本研究結(jié)果提示,雙側(cè)IPH患者的斑塊易損性明顯重于單側(cè)IPH患者,需要臨床加以關(guān)注。2.新鮮出血的體積是FCR的獨立相關(guān)因子,不同時期出血的體積可為判斷斑塊FCR發(fā)生的可能性提供參考依據(jù)。
[Abstract]:Objective: to apply high resolution magnetic resonance imaging of carotid artery. To investigate the relationship between intraplaque hemorrhage (IPH) and plaque stability. Materials and methods: 1. To explore the relationship between IPH and plaque stability in bilateral plaques: a retrospective analysis of carotid arteries in our hospital from December 2009 to December 2012. Patients with high resolution magnetic resonance imaging, Forty-four patients with IPH were divided into two groups according to unilateral and bilateral IPH: unilateral group (30 cases) and bilateral group (14 cases). The fibrous cap status between the two groups was analyzed by Wilcoxon rank sum test and chi-square test logistic regression analysis. Analysis of plaque vulnerability and age differences. 2. To explore the correlation between IPH bleeding period and volume and fibrous cap rupture: a retrospective analysis was conducted from December 2009 to December 2012 in our hospital for high resolution magnetic resonance (HRM) of carotid artery. Resonance examination of the patient, There were 37 patients with IPH and 41 plaques. The plaques were divided into FCR group (27 cases) and no FCR group (27 cases) and no FCR group (14 cases). The incidence of FCR was calculated and the fresh bleeding and recent bleeding were measured. Volume of total bleeding. Wilcoxon rank sum test, chi-square test, Correlation test and Logistic regression analysis were used to analyze the correlation between the volume of hemorrhage and FCR in each stage. Results: 1.The age of bilateral IPH group was lower than that of unilateral IPH group (66.62 鹵9.36 years old vs 73.70 鹵9.06 years old vs 0.027), and that of bilateral IPH group was the largest. The incidence of plaque thickness (6.34 鹵1.93mm vs 5.05 鹵1.25mm P0.035) and ulcers (50 vs. 13.3 vs 0.025) was significantly higher than that of patients with unilateral IPH by logistic regression analysis. There was a significant correlation between bilateral IPH and the occurrence of ulcers. After model 1 adjusted for sex, there was still a significant correlation between bilateral IPH and ulcers. However, in model 2, the additional correction age (P0.131) or the maximum thickness of plaque was 0.139). There was no significant correlation between bilateral IPH and ulceration. 2. The volume of fresh bleeding in plaque with FCR was significantly larger than that in plaque without FCR (109.83 鹵75.49 mm3 vs.30.54 鹵20.62mm ~ 0.002). Logogisc regression analysis showed the correlation between hemorrhage volume and FCR. The volume OR value of fresh bleeding was 1.74 95% CIQ 1.13-2.67, and the volume OR of recent bleeding was 1.36 ~ 95 CI, 0.84-2.18 ~ 0.2080.The OR values of fresh bleeding volume and recent bleeding volume were 1.78 95 CI 1.12-2.82 (P0. 015) and 1. 4395 CI 0. 86-2. 38. P=0.172).ROC curve analysis showed that, after adjusting for various factors, the OR values of fresh bleeding and recent bleeding volume were 1.78 95 CI 1.12-2.82 (P0. 015) and 1. 4395% CI 0.86-2.38, respectively. P=0.172).ROC curve analysis showed that the volume of fresh bleeding and the volume of recent bleeding were 1.78 95 CI 1.12-2.82) and 1.4395 CI 0.86-2.38, respectively. The AUC of fresh hemorrhage volume was significantly larger than that of recent bleeding volume AUC: 0.79 vs 0.64. Conclusion compared with unilateral IPH patients, bilateral IPH patients are younger in age, heavier in plaque load, and higher in the incidence of ulcers. The plaque vulnerability of bilateral IPH patients is significantly more severe than that of unilateral IPH patients. 2. The volume of fresh bleeding is an independent factor related to FCR. The volume of bleeding in different periods can provide a reference for judging the possibility of plaque FCR.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.4;R445.1

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