Analysis on the characteristics of middle cerebral arterial plaque in young and middle-aged patients with acute ischemic cerebrovascular disease
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摘要:
目的 应用高分辨率磁共振血管壁成像研究中青年急性缺血性脑血管病大脑中动脉斑块的特点。 方法 收集2018年6月—2020年2月于中国科学技术大学附属第一医院神经内科住院的74例中青年急性缺血性卒中或短暂性脑缺血发作患者资料,责任血管均为大脑中动脉,利用高分辨率磁共振评估斑块分布位置、性质,比较症状侧和无症状侧大脑中动脉和不同性质斑块的位置分布特点。 结果 共扫描74例患者,其中颅内动脉粥样斑块62例,共124根大脑中动脉,其中症状侧血管48根(38.7%),非症状侧血管76根(61.3%)。血管内存在斑块96根,稳定斑块39根(40.6%),不稳定斑块57根(59.4%);上侧16根(16.7%),下侧38根(39.6%),背侧10根(10.4%),腹侧32根(33.3%)。症状侧和非症状侧大脑中动脉不稳定斑块分别有41根和16根(P < 0.01);稳定斑块和不稳定脉斑块位置(腹侧10根vs. 22根,背侧2根vs. 8根,上侧5根vs. 11根,下侧22根vs. 16根,P < 0.05);症状侧和非症状大脑中动脉斑块位置(腹侧16根vs. 16根,背侧6根vs. 4根,上侧9根vs. 7根,下侧14根vs. 24根,P>0.05)。 结论 中青年急性缺血性脑血管病患者大脑中动脉斑块主要分布于血管的下侧和腹侧,症状侧斑块性质多为不稳定斑块,多分布在大脑中动脉的腹侧、背侧和上侧。 Abstract:Objective To study the characteristics of middle cerebral artery plaques in young and middle-aged adults with acute ischemic cerebrovascular disease using high-resolution magnetic resonance vessel wall imaging. Methods We collected 74 young and middle-aged patients with acute ischemic stroke or transient ischemic attack hospitalised from June 2018 to February 2020 using high-resolution magnetic resonance imaging to evaluate the location and nature of plaques and to compare the location distribution characteristics of symptomatic and asymptomatic middle cerebral arteries and plaques of different properties. Results There were 74 patients, including 62 cases of intracranial atherosclerotic plaque. A total of 124 middle cerebral arteries were scanned by magnetic resonance imaging in 62 patients, of which 48 were symptomatic side vessel roots (38.7%) and 76 were non-symptomatic lateral vessels (61.3%). There were 96 plaques, 39 stable plaques (40.6%), 57 unstable plaques (59.4%), 16 superior plaques (16.7%), 38 inferior plaques (39.6%), 10 dorsal plaques (10.4%) and 32 ventral plaques (33.3%). There were 41 and 16 symptomatic and non-symptomatic central cerebral artery unstable plaques (P < 0.01); stable plaques and unstable plaque locations (ventral 10 vs. 22, dorsal 2 vs. 8, superior 5 vs. 11, inferior side 22 vs. 16, all P < 0.05); symptomatic side and non-symptomatic middle cerebral artery plaque location (ventral 16 vs. 16, dorsal 6 vs. 4, superior 9 vs. 7, inferior 14 vs. 24, all P < 0.05). Conclusion The middle cerebral artery plaques in young and middle-aged patients with acute ischemic cerebrovascular disease are mainly distributed in the lower and ventral side of the blood vessels, and the properties of symptomatic plaques are mostly unstable plaques, which tend to be distributed in the ventral, dorsal and upper side of the middle cerebral artery. -
表 1 不同性别ICAD患者基线资料比较
性别 例数 年龄 高血压 白细胞 血小板 血糖 TG TC Hcy LDL-C NIHSS (x±s,岁) (例) (x±s,×109/L) (x±s,×109/L) (x±s,mmol/L) (x±s,mmol/L) (x±s,mmol/L) (x±s,μmol/L) (x±s,mmol/L) (x±s,分) 男性 47 47.32±7.83 32 6.97±1.65 196.74±42.62 5.40±1.51 1.76±1.16 4.13±1.25 15.22±10.19 2.38±1.02 2.62±3.11 女性 15 47.53±8.89 9 6.69±1.74 223.67±55.61 4.98±0.83 1.49±0.68 3.73±0.92 10.37±4.17 1.82±0.72 1.87±2.70 统计量 -0.089a 0.332b 0.575a -1.974a 1.025a 0.884a 1.145a 1.731a 1.978a 0.838a P值 0.929 0.565 0.567 0.053 0.310 0.380 0.257 0.089 0.053 0.405 注:NIHSS为美国国立卫生研究院卒中量表;a为t值, b为χ2值。 表 2 症状侧和非症状侧MCA斑块性质比较(根)
血管位置 血管根数 斑块性质 稳定 不稳定 症状侧 45 4 41 非症状侧 51 35 16 注:不同位置MCA斑块性质比较,χ2=35.369,P < 0.001。 表 3 症状侧和非症状侧MCA斑块、稳定和不稳定斑块位置比较(根)
斑块位置 血管性质 斑块性质 合计 症状侧 非症状侧 稳定 不稳定 腹侧 16 16 10 22 32 背侧 6 4 2 8 10 上侧 9 7 5 11 16 下侧 14 24 22 16 38 χ2值 2.918 8.211 P值 0.404 0.042 -
[1] 中国卒中学会, 中国卒中学会神经介入分会, 中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2018[J]. 中国卒中杂志, 2018, 13(7): 706-729. doi: 10.3969/j.issn.1673-5765.2018.07.014 [2] GUAN T J, MA J, LI M, et al. Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013[J]. Neurology, 2017, 89(1): 53-61. doi: 10.1212/WNL.0000000000004056 [3] 王陇德, 刘建民, 杨弋, 等. 《中国脑卒中防治报告2017》概要[J]. 中国脑血管病杂志, 2018, 15(11): 611-617. doi: 10.3969/j.issn.1672-5921.2018.11.010 [4] WONG L K. Global burden of intracranial atherosclerosis[J]. Int J Stroke, 2006, 1(3): 158-159. doi: 10.1111/j.1747-4949.2006.00045.x [5] WANG Y, ZHAO X, LIU L, et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: The Chinese Intracranial Atherosclerosis (CICAS) Study[J]. Stroke, 2014, 45(3): 663-669. doi: 10.1161/STROKEAHA.113.003508 [6] WAN L, ZHANG N, ZHANG L, et al. Reproducibility of simultaneous imaging of intracranial and extracranial arterial vessel walls using an improved T1-weighted DANTE-SPACE sequence on a 3T MR system[J]. Magn Reson Imaging, 2019, 62: 152-158. doi: 10.1016/j.mri.2019.04.016 [7] RYU C W, KWAK H S, JAHNG G H, et al. High-resolution MRI of intracranial atherosclerotic disease[J]. Neurointervention, 2014, 9(1): 9-20. doi: 10.5469/neuroint.2014.9.1.9 [8] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. doi: 10.3760/cma.j.issn.1006-7876.2018.09.004 [9] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J]. 中华神经科杂志, 2015, 48(4): 258-273. doi: 10.3760/cma.j.issn.1006-7876.2015.04.003 [10] 姜超, 王钰, 陈蓓蕾, 等. 应用高分辨率磁共振对症状性大脑中动脉斑块稳定性危险因素的研究[J]. 中风与神经疾病杂志, 2020, 37(4): 330-332. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFSJ202004014.htm [11] XU W H, LI M L, GAO S, et al. Plaque distribution of stenotic middle cerebral artery and its clinical relevance[J]. Stroke, 2011, 42(10): 2957-2959. doi: 10.1161/STROKEAHA.111.618132 [12] 李学军, 章微微, 付金英, 等. 社会关系质量对中青年首发脑卒中患者早期创伤后应激障碍的影响[J]. 中华全科医学, 2017, 15(3): 483-486. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201703038.htm [13] LI F, YANG L, YANG R, et al. Ischemic stroke in young adults of Northern China: Characteristics and risk factors for recurrence[J]. Eur Neurol, 2017, 77(3-4): 115-122. doi: 10.1159/000455093 [14] DE HAVENON A, MOSSA-BASHA M, SHAH L, et al. High-resolution vessel wall MRI for the evaluation of intracranial atherosclerotic disease[J]. Neuroradiology, 2017, 59(12): 1193-1202. doi: 10.1007/s00234-017-1925-9 [15] VAN DER KOLK A G, ZWANENBURG J J, BRUNDEL M, et al. Distribution and natural course of intracranial vessel wall lesions in patients with ischemic stroke or TIA at 7.0 Tesla MRI[J]. Eur Radiol, 2015, 25(6): 1692-1700. doi: 10.1007/s00330-014-3564-4 [16] DIELEMAN N, VAN DER KOLK A G, ZWANENBURG J J, et al. Imaging intracranial vessel wall pathology with magnetic resonance imaging: Current prospects and future directions[J]. Circulation, 2014, 130(2): 192-201. doi: 10.1161/CIRCULATIONAHA.113.006919 [17] QIAO Y, STEINMAN D A, QIN Q, et al. Intracranial arterial wall imaging using three-dimensional high isotropic resolution black blood MRI at 3.0 Tesla[J]. J Magn Reson Imaging, 2011, 34(1): 22-30. doi: 10.1002/jmri.22592 [18] ACHENBACH S. Imaging the vulnerable plaque on coronary CTA[J]. JACC Cardiovasc Imaging, 2020, 13(6): 1418-1421. doi: 10.1016/j.jcmg.2019.11.006 [19] QIAO Y, ZEILER S R, MIRBAGHERI S, et al. Intracranial plaque enhancement in patients with cerebrovascular events on high-spatial-resolution MR images[J]. Radiology, 2014, 271(2): 534-542. doi: 10.1148/radiol.13122812 [20] KIM J M, JUNG K H, SOHN C H, et al. Intracranial plaque enhancement from high resolution vessel wall magnetic resonance imaging predicts stroke recurrence[J]. Int J Stroke, 2016, 11(2): 171-179. doi: 10.1177/1747493015609775 [21] 肖嘉昱, 蒋涛, 杨旗, 等. 短暂性脑缺血发作患者颅内动脉斑块特征的高分辨率磁共振研究[J]. 中国医学影像学杂志, 2019, 27(8): 578-583. doi: 10.3969/j.issn.1005-5185.2019.08.005 [22] ZHAO D L, DENG G, XIE B, et al. High-resolution MRI of the vessel wall in patients with symptomatic atherosclerotic stenosis of the middle cerebral artery[J]. J Clin Neurosci, 2015, 22(4): 700-704. doi: 10.1016/j.jocn.2014.10.018 [23] CHOI Y J, JUNG S C, LEE D H. Vessel wall imaging of the intracranial and cervical carotid arteries[J]. J Stroke, 2015, 17(3): 238-255. doi: 10.5853/jos.2015.17.3.238 [24] ZHANG D F, CHEN Y C, CHEN H, et al. A high-resolution MRI study of relationship between remodeling patterns and ischemic stroke in patients with atherosclerotic middle cerebral artery stenosis[J]. Front Aging Neurosci, 2017, 9: 140. doi: 10.3389/fnagi.2017.00140