本文選題：顱內(nèi)動脈粥樣硬化性疾病 + 高分辨磁共振��； 參考：《首都醫(yī)科大學》2017年碩士論文

【摘要】：目的:癥狀性顱內(nèi)動脈粥樣硬化性疾病(SICAD)的發(fā)病率、復發(fā)率均較高,其導致肢體殘疾、認知障礙及卒中后抑郁的風險對社會和家庭均構(gòu)成了重大威脅。高分辨磁共振(HR-MRI)技術(shù)可通過顯示顱內(nèi)動脈斑塊纖維帽完整性、斑塊內(nèi)出血以及斑塊強化等特征反映斑塊穩(wěn)定性,但對斑塊進行定量分析的研究尚少。他汀類藥物可增加斑塊穩(wěn)定性、降低其破裂風險,但應用HR-MRI技術(shù)觀察他汀類藥物對于顱內(nèi)動脈斑塊作用效果的研究較少。本研究擬通過對比SICAD癥狀側(cè)血管與非癥狀側(cè)血管的管壁形態(tài)、斑塊特征及其強化特征,探索不穩(wěn)定斑塊的量化評價方法以及他汀對動脈粥樣硬化斑塊各項特征的影響。研究對象與方法:2015年4月至2017年3月,經(jīng)篩選后對56例就診于首都醫(yī)科大學宣武醫(yī)院的SICAD患者,進行兩個步驟的分組,第一步:根據(jù)狹窄血管是否為責任血管分為癥狀組與非癥狀組;第二步:對于癥狀組患者,根據(jù)發(fā)病前是否服用他汀類藥物分為未用他汀組和服用他汀組。所有患者均于3.0T核磁共振行3D-SPACE序列黑血技術(shù)掃描,重建后測量血管狹窄最嚴重處及參考血管的血管面積(outer wall area OWA)、管腔面積(lumen area LA)、打藥前后斑塊信號強度等,計算管壁面積(wall area WA)、狹窄程度(stenosis degree SD)、斑塊負荷(plaque burden PB)、管壁強化指數(shù)(enhancement index EI)等指標,分析:(1)癥狀組血管與非癥狀組血管各項特征的差異,應用ROC曲線對比各量化指標的曲線下面積;(2)比較未用他汀組與服用他汀組管壁各項指標的不同,評估發(fā)病前他汀類藥物對于顱內(nèi)動脈斑塊特征的影響。結(jié)果:(1)與非癥狀組相比,癥狀組管腔面積明顯更小、斑塊負荷及狹窄程度更重(P0.05);增強后斑塊信號、管壁指數(shù)更高(P=0.012、0.031);取95%可信區(qū)間(CI)對比以上各指標的ROC曲線下面積(AUC),差異無統(tǒng)計學意義(P0.05)。(2)與未用他汀組相比,應用他汀組斑塊強化體積減小(P=0.046),余管壁形態(tài)、斑塊特征及強化特征的差異無統(tǒng)計學意義(P0.05)。結(jié)論:HR-MRI黑血技術(shù)可實現(xiàn)管壁各項特征的量化評估,尤其對于不穩(wěn)定斑塊的特征識別具有較高的特異性及靈敏性。其中管腔面積、狹窄程度、斑塊負荷、增強后斑塊信號、管壁指數(shù)可作為斑塊易損性的參考指標,用于高�；颊叩暮Y選及其個體化診療。發(fā)病前他汀的應用可減小斑塊強化部分的體積,隨LDL-C水平的降低,他汀減小斑塊強化部分的作用增加。
[Abstract]:Objective: the incidence and recurrence rate of symptomatic intracranial atherosclerotic disease (SICAD) are high. The risk of physical disability, cognitive impairment and post-stroke depression pose a great threat to society and family. High-resolution magnetic resonance imaging (HR-MRI) technique can reflect plaque stability by displaying the integrity of the fibrous cap of intracranial artery plaque, intraplaque hemorrhage and plaque enhancement, but the quantitative analysis of plaque is still rare. Statins can increase plaque stability and reduce the risk of plaque rupture, but there is little research on the effect of statins on intracranial artery plaque by HR-MRI technique. The aim of this study was to investigate the quantitative evaluation of unstable plaques and the effects of statins on the characteristics of atherosclerotic plaques by comparing the wall morphology, plaque characteristics and enhancement characteristics of symptomatic and non-symptomatic vessels of SICAD. Subjects and methods: from April 2015 to March 2017, 56 SICAD patients who were admitted to Xuanwu Hospital of Capital Medical University were divided into two groups. The first step was divided into symptomatic group and non-symptomatic group according to whether the stenotic vessel was responsible; the second step was that the patients in the symptom group were divided into two groups according to whether or not to take statins before onset. All the patients were scanned by 3D-SPACE sequence black blood technique at 3.0T MRI. After reconstruction, the area of wall area OWAA, lumen area LAA, and the signal intensity of plaque before and after treatment were measured. In order to analyze the differences of vascular characteristics between symptomatic group and symptomatic group, we calculated the wall area, stenosis degree, plaque load, enhancement index EIe, etc, and analyzed the differences of vascular characteristics between symptomatic group and asymptomatic group. ROC curve was used to compare the area under the curve of each quantitative index) to compare the differences of the wall indexes between the untreated group and the group treated with statins, and to evaluate the effect of statins on the plaque characteristics of intracranial artery before onset. Results compared with the asymptomatic group, the lumen area of the symptomatic group was significantly smaller, the plaque load and the degree of stenosis were heavier than that of the non-symptomatic group, and the plaque signal was enhanced. The area under the ROC curve of 95% CI was compared with that of the control group. There was no significant difference in the area under the ROC curve. There was no significant difference between the two groups. Compared with the group without statin, the enhancement volume of plaque in the statin group was decreased by 0.046, and the shape of the remaining wall was decreased. There was no significant difference in plaque characteristics and enhancement features between the two groups (P 0.05). Conclusion the mass HR-MRI black blood technique can be used to quantitatively evaluate the characteristics of vascular wall, especially for the feature recognition of unstable plaques with high specificity and sensitivity. Among them, lumen area, stenosis degree, plaque load, plaque signal after enhancement, wall index can be used as a reference index for plaque vulnerability, which can be used for screening and individualized diagnosis and treatment of high-risk patients. The effect of statins on plaque enhancement was increased with the decrease of LDL-C level.
【學位授予單位】：首都醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743

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