Page 68 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第41卷第12期
·1774 · Journal of Nanjing Medical University（Natural Sciences） 2021年12月

·临床医学·

大脑中动脉高分辨率MR斑块特征与缺血性卒中复发的相关性

研究

任舒静 ，王兆露 ，苏春秋 ，施海彬 ，吴飞云 ，洪汛宁 ，鲁珊珊 1
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南京医科大学第一附属医院放射科，神经内科，江苏 南京 210029
1 2
［摘 要］ 目的：采用高分辨血管壁成像（high⁃resolution vessel wall imaging，HR⁃VWI）探讨大脑中动脉（middle cerebral artery，
MCA）斑块特征与缺血性卒中复发的相关性。方法：回顾性分析本院105例经血管壁成像确认MCA存在斑块的患者资料，根
据有无狭窄血管同侧急性缺血性卒中事件及其发生次数分为初发组（n=61）、复发组（n=19）、非症状组（n=25）。采用方差分
析、卡方检验、Fisher精确概率法或Kruskal⁃Wallis检验对比分析3组患者MCA狭窄率、重构指数及斑块特征（强化比率、强化等
级、斑块负荷、T1高信号、斑块位置）。将与复发可能相关的危险因素进行Logistic回归分析。结果：复发组及初发组与非症状
组比较，均具有更大的斑块负荷、强化比率及更多的正性重构（P 均<0.05）。复发组与初发组比较，有更大的斑块负荷（P=
0.005）、管腔狭窄率（P=0.006）及更多的环周斑块（P=0.008）。多因素分析示斑块负荷是与复发相关的唯一独立危险因素（OR=
1.075，95%CI：1.019~1.133，P=0.008）。结论：斑块负荷是与MCA缺血性卒中复发相关的独立危险因素，可作为预警缺血性卒
中复发的有效影像学标志物。
［关键词］ 卒中；高分辨血管壁成像；动脉粥样硬化
［中图分类号］ R445.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）12⁃1774⁃06
doi：10.7655/NYDXBNS20211210

The relationship between MCA plaque features on HR⁃VWI and acute ischemic stroke/
TIA recurrence
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REN Shujing ，WANG Zhaolu ，SU Chunqiu ，SHI Haibin ，WU Feiyun ，HONG Xunning ，LU Shanshan 1
Department of Radiology，Department of Neurology，the First Affiliated Hospital of Nanjing Medical University，
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Nanjing 210029，China
［Abstract］ Objective：This study aims to investigate the relationship between middle cerebral artery（MCA）plaque features on high⁃
resolution vessel wall imaging（HR⁃VWI）and acute ischemic stroke/TIA recurrence. Methods：The HR⁃VWI and clinical data of 105
patients with atherosclerotic plaques on MCA were retrospectively analyzed. They were divided into group 1，with the first episode of
acute ischemic stroke/TIA（n=61）；group 2，with recurrent acute ischemic stroke/TIA（n=19）；group 3，with no occurrence of clinical
event（n=25）. The degree of stenosis，remodeling index and plaque features（enhancement ratio，enhancement grade，plaque burden，T1
signal intensity，and plaque distribution）were measured and compared among groups using analysis of variance，chi⁃square，Fisher’s
exact test or Kruskal ⁃ Wallis test. Regression models investigated risk factors for recurrent stroke/TIA. Results：Plaque burden，
enhancement ratio，remodeling index were all significantly higher in group 1 and 2，compared to group 3（all P < 0.05）. Higher plaque
burden（P=0.005），higher stenosis degree（P=0.006）and more concentric plaque（P=0.008）were found in group 2 compared to group 1
（P < 0.05）. Multivariable logistic regression shows plaque burden was the only significant plaque marker associated with recurrent
stroke/TIA（OR=1.075，95% CI 1.019~1.133，P=0.008）. Conclusion：Higher plaque burden of MCA was independently associated
with recurrent acute ischemic stroke/TIA and can be an effective imaging marker for alarming the ischemic stroke recurrence.
［Key words］ stroke；high resolution vessel wall imaging；atherosclerosis
［J Nanjing Med Univ，2021，41（12）：1774⁃1779］