癥狀性顱內動脈狹窄的高分辨磁共振及陰陽類證分型研究
發(fā)布時間：2018-11-27 20:54
【摘要】：目的： 應用3.0T高分辨率磁共振成像(high resolution magnetic resonance imaging, HR-MRI)探討癥狀性顱內動脈粥樣硬化性狹窄的動脈管壁和斑塊特性及血管內介入治療對動脈管壁和斑塊性質的影響；同時觀察急性缺血性中風患者的陰陽類證分型與其影像學相關指標是否存在相關性。 方法： 1.回顧性的分析2011年2月至2014年2月收治的已行3. OT HR-MRI檢查的癥狀性顱內動脈粥樣硬化性狹窄患者的一般資料及HR-MRI資料。對所納入患者的性別、年齡、危險因素、狹窄部位、臨床癥狀、陰陽類證及斑塊性質進行頻數(shù)分布描述性分析。 2.根據(jù)HR-MRI掃描結果粗略測量出動脈最狹窄處及參考處血管面積(VA),計算出重構率RI=最狹窄處VA/參考處VA,設定RI≥1.05為PR組,RI1.05為非PR組,對比分析兩組之間性別、年齡、危險因素、狹窄部位、臨床癥狀及斑塊性質是否存在差異。 3.對所納入患者中已行血管內介入治療,并于手術前后均有行HR-MRI檢查患者的手術前后3.OT HR-MRI結果進行分析,探討血管內介入治療前后顱內動脈管壁和斑塊性質的變化。 4.對符合納入標準患者的陰陽類證分型進行構成比分析,并對陰陽類證與某些影像學指標的關系予以研究。 結果： 1.本研究共納入22例符合條件的患者,其中男性17人,女性5人,平均年齡59.27±8.795歲；腦梗死患者15例,TIA患者7例；BA狹窄12例,MCA狹窄10例；合并高血壓病17例,糖尿病10例,血脂異常14例,既往卒中6例,有吸煙者11例；其中陰類證患者16例,陽類證患者6例。22例患者的靶病變處HR-MRI上均可見不同程度的偏心斑塊；在T1WI上,2例可見點狀低信號,提示鈣化可能,1例可見斑塊內高信號,考慮斑塊內出血可能；15例在T2WI上可見臨近管腔的高信號帶,考慮為纖維帽成分；7例在壓脂像上可見斑塊內信號明顯抑制,考慮斑塊內脂質核心形成；注射對比劑后,16例在CE-T1WI像上可見強化。 2.本研究22例患者中,狹窄處血管正性重構15例,非正性重構7例。PR組與非PR組之間危險因素的比較中,PR組糖尿病患者更多,具有統(tǒng)計學差異(P=0.045)。兩組之間年齡、性別、其他危險因素、狹窄部位及臨床癥狀的比較無統(tǒng)計學意義。PR組與非PR組之間斑塊性質的比較顯示,PR組可見更多的脂質核心及強化,兩者之間的差異均具有統(tǒng)計學意義。 3.本研究22例患者中行血管內介入治療的7例,行單純Gateway球囊擴張治療1例,行Gateway球囊擴張+Wingspan支架成形術治療6例。1例行單純球囊擴張治療的病例,手術后HR-MRI可見斑塊性質變得不穩(wěn)定。6例行球囊擴張+支架成形術治療的患者,其中1例術后HR-MRI提示斑塊可能存在變形和移位,斑塊性質同術前,仍不穩(wěn)定；1例術后HR-MRI提示仍有偏心斑塊存在,但性質較穩(wěn)定；4例術后HR-MRI提示斑塊消失,管腔通暢,支架與血管內膜融合良好。所有患者隨訪時間均在半年以上,均沒有再發(fā)生同一動脈供血區(qū)的缺血和卒中事件。 4.本研究中陰類證患者共16例,陽類證患者共6例。陰陽類證與性別、年齡、不同卒中危險因素、狹窄部位、斑塊性質及血管重構型之間的關系均無統(tǒng)計學意義(P0.05)。 結論： 1.在一定程度上,高分辨率磁共振成像技術可以顯示顱內動脈管壁結構及斑塊性質,并通過壓脂成像及增強掃描成像可以對斑塊的穩(wěn)定性進行初步的評估,但其準確性有待提高。 2.癥狀性顱內動脈粥樣硬化性狹窄患者中PR更為多見,相比之下非PR雖然所占比例不高,但確實存在。糖尿病有可能是導致PR的一個重要因素,而且在PR患者中可以見到更多的斑塊內脂質核心及斑塊強化,提示正性重構的斑塊不穩(wěn)定。 3.單純球囊擴張可改變顱內動脈管壁的結構,可能使斑塊變得不穩(wěn)定。支架成形術由于支架的貼附作用,對保持管壁結構的穩(wěn)定性有益。3.0T HR-MRI技術可較清晰的顯示血管內介入治療前后動脈管壁和斑塊特征的變化,可用于評估血管內介入治療對顱內動脈管壁結構和斑塊的的影響。 4.急性缺血性中風患者中陰類證更為多見。陰類證與陽類證的比較中性別、年齡、危險因素、狹窄部位及斑塊性質均無明顯差異,提示陰陽類證分型具有普遍意義,其反映的是患者全部病理因素的綜合表現(xiàn),體現(xiàn)了中醫(yī)學的整體觀念。
[Abstract]:Purpose: Application of high resolution magnetic resonance imaging (HR-MRI) in symptomatic intracranial atherosclerosis with high resolution magnetic resonance imaging (HR-MRI) In response, the positive and negative types of the patients with acute ischemic stroke were observed to be related to their imaging-related indexes. Sex. Method: 1. Retrospective analysis from February 2011 to February 2014 General data and HR for symptomatic intracranial atherosclerotic stenosis who have been treated with 3. OT HR-MRI MRI data. Frequency distribution of sex, age, risk factors, stenosis, clinical symptoms, yin-yang and plaque properties of the included patient Descriptive analysis. 2. The blood vessel area (VA) at the most narrow artery and the reference area of the artery was roughly measured according to the HR-MRI scan results. The reconstruction rate RI was calculated as the VA at the most narrow place, VA at the reference place, and the RI-1.05 was the PR group, and the R1.1. 05 was the non-PR group, and the sex, age, risk between the two groups were compared and analyzed. Factors, Stenosis, Clinical Symptoms, and Plaque Whether there was a difference in quality. 3. Intravascular interventional therapy was performed on the included patients, and before and after the operation, the results of the 3. OT HR-MRI were analyzed before and after the operation, and the intracranial arterial tubes before and after the endovascular intervention were discussed. The change of the property of the wall and the plaque. 4. The composition ratio analysis of the type of yin and yang in the standard patient is made, and the yin and yang syndrome and some shadow like the finger of learning The results were as follows: 1. A total of 22 eligible patients were included in the study, including 17 males and 5 females, with an average age of 59. 27 and 8. 795 years; 15 patients with cerebral infarction, 7 patients with TIA, 12 patients with BA stenosis and 10 MCA stenosis; and There were 17 cases of hypertension, 10 cases of diabetes, 14 cases of dyslipidemia, 6 cases of prior stroke and 11 cases of smokers. On T 1WI, 2 cases of low-point low-signal showed that calcification was possible, 1 case of high signal in the visible plaque, considering the possibility of intraplaque internal hemorrhage, 15 cases of high signal band near the tube cavity on T2WI were considered as fiber cap components, and 7 cases of intraplaque signal were observed on the pressure-fat image. obvious inhibition, taking into account the core formation of the lipid in the plaque; after injection of the contrast agent, 16 an enhancement was seen in the CE-T1WI image. 2. Of the 22 patients in this study, the stenosis In the comparison of the risk factors between the PR and non-PR groups, there were more patients with diabetes in the PR group than in the non-PR group. with statistical difference (P = 0.045). Age, sex, other risk factors between the two groups, narrow There was no statistical significance between the narrow part and the clinical symptoms. The comparison of the plaque properties between the PR group and the non-PR group showed that the PR group can see more lipid core and strong The difference between the two groups was statistically significant. 6 cases were treated with simple balloon dilatation, and the post-operative HR-MRI showed that the properties of the plaque were unstable. 6 cases of patients treated with balloon dilatation + stent-plasty, 1 of the patients with the post-operative HR-MRI showed that the plaque could be deformed and displaced, and the properties of the plaque were not stable before and after the operation; 1 The post-operative HR-MRI showed the presence of the eccentric patch, but the character was stable, and the HR-MRI in 4 cases showed the plaque. disappeared, the tube cavity is smooth, the stent is well fused with the blood vessel, all the patients follow-up time is more than half a year, none There were ischemia and stroke events in the same arterial blood supply area. 4. In the study, there were 16 cases of yin-yang syndrome and 6 cases of male-type syndrome. The yin-yang syndrome and sex, age, risk factors of different stroke, the narrow part, the nature of the plaque and the weight of the blood vessel configurational Conclusion: 1. In a certain extent, the high-resolution magnetic resonance imaging technique can display the structure of the tube wall of the intracranial artery and the character of the plaque, and can be used to image and enhance the scanning imaging by the pressure-fat imaging and the enhanced scanning. in order to evaluate the stability of the plaque, the accuracy of the plaque is to be improved. R is more common, compared with non-PR, although the proportion of non-PR is not high, but does exist. Diabetes is likely to be an important factor in the PR, and more can be seen in PR patients The core of the plaque and the enhancement of the plaque in the plaque suggest that the plaque of the positive reconstruction is not stable. The simple balloon expansion can change the structure of the tube wall of the intracranial artery, which can make the plaque unstable. The stent is beneficial to the stability of the tube wall structure due to the attachment of the stent. The 3. 0T HR-MRI technique can show the changes of the arterial wall and the plaque characteristics before and after the intravascular interventional therapy. and can be used for evaluating the intravascular interventional treatment on the tube wall of the intracranial artery. The effect of the structure and plaque in the patients with acute ischemic stroke is more obvious. The sex, age, risk factors, the narrow part and the character of the plaque in the comparison of the syndrome of yin and yang have no significant difference, and it is suggested that the type of yin and yang is of universal significance.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3
本文編號：2362010
[Abstract]:Purpose: Application of high resolution magnetic resonance imaging (HR-MRI) in symptomatic intracranial atherosclerosis with high resolution magnetic resonance imaging (HR-MRI) In response, the positive and negative types of the patients with acute ischemic stroke were observed to be related to their imaging-related indexes. Sex. Method: 1. Retrospective analysis from February 2011 to February 2014 General data and HR for symptomatic intracranial atherosclerotic stenosis who have been treated with 3. OT HR-MRI MRI data. Frequency distribution of sex, age, risk factors, stenosis, clinical symptoms, yin-yang and plaque properties of the included patient Descriptive analysis. 2. The blood vessel area (VA) at the most narrow artery and the reference area of the artery was roughly measured according to the HR-MRI scan results. The reconstruction rate RI was calculated as the VA at the most narrow place, VA at the reference place, and the RI-1.05 was the PR group, and the R1.1. 05 was the non-PR group, and the sex, age, risk between the two groups were compared and analyzed. Factors, Stenosis, Clinical Symptoms, and Plaque Whether there was a difference in quality. 3. Intravascular interventional therapy was performed on the included patients, and before and after the operation, the results of the 3. OT HR-MRI were analyzed before and after the operation, and the intracranial arterial tubes before and after the endovascular intervention were discussed. The change of the property of the wall and the plaque. 4. The composition ratio analysis of the type of yin and yang in the standard patient is made, and the yin and yang syndrome and some shadow like the finger of learning The results were as follows: 1. A total of 22 eligible patients were included in the study, including 17 males and 5 females, with an average age of 59. 27 and 8. 795 years; 15 patients with cerebral infarction, 7 patients with TIA, 12 patients with BA stenosis and 10 MCA stenosis; and There were 17 cases of hypertension, 10 cases of diabetes, 14 cases of dyslipidemia, 6 cases of prior stroke and 11 cases of smokers. On T 1WI, 2 cases of low-point low-signal showed that calcification was possible, 1 case of high signal in the visible plaque, considering the possibility of intraplaque internal hemorrhage, 15 cases of high signal band near the tube cavity on T2WI were considered as fiber cap components, and 7 cases of intraplaque signal were observed on the pressure-fat image. obvious inhibition, taking into account the core formation of the lipid in the plaque; after injection of the contrast agent, 16 an enhancement was seen in the CE-T1WI image. 2. Of the 22 patients in this study, the stenosis In the comparison of the risk factors between the PR and non-PR groups, there were more patients with diabetes in the PR group than in the non-PR group. with statistical difference (P = 0.045). Age, sex, other risk factors between the two groups, narrow There was no statistical significance between the narrow part and the clinical symptoms. The comparison of the plaque properties between the PR group and the non-PR group showed that the PR group can see more lipid core and strong The difference between the two groups was statistically significant. 6 cases were treated with simple balloon dilatation, and the post-operative HR-MRI showed that the properties of the plaque were unstable. 6 cases of patients treated with balloon dilatation + stent-plasty, 1 of the patients with the post-operative HR-MRI showed that the plaque could be deformed and displaced, and the properties of the plaque were not stable before and after the operation; 1 The post-operative HR-MRI showed the presence of the eccentric patch, but the character was stable, and the HR-MRI in 4 cases showed the plaque. disappeared, the tube cavity is smooth, the stent is well fused with the blood vessel, all the patients follow-up time is more than half a year, none There were ischemia and stroke events in the same arterial blood supply area. 4. In the study, there were 16 cases of yin-yang syndrome and 6 cases of male-type syndrome. The yin-yang syndrome and sex, age, risk factors of different stroke, the narrow part, the nature of the plaque and the weight of the blood vessel configurational Conclusion: 1. In a certain extent, the high-resolution magnetic resonance imaging technique can display the structure of the tube wall of the intracranial artery and the character of the plaque, and can be used to image and enhance the scanning imaging by the pressure-fat imaging and the enhanced scanning. in order to evaluate the stability of the plaque, the accuracy of the plaque is to be improved. R is more common, compared with non-PR, although the proportion of non-PR is not high, but does exist. Diabetes is likely to be an important factor in the PR, and more can be seen in PR patients The core of the plaque and the enhancement of the plaque in the plaque suggest that the plaque of the positive reconstruction is not stable. The simple balloon expansion can change the structure of the tube wall of the intracranial artery, which can make the plaque unstable. The stent is beneficial to the stability of the tube wall structure due to the attachment of the stent. The 3. 0T HR-MRI technique can show the changes of the arterial wall and the plaque characteristics before and after the intravascular interventional therapy. and can be used for evaluating the intravascular interventional treatment on the tube wall of the intracranial artery. The effect of the structure and plaque in the patients with acute ischemic stroke is more obvious. The sex, age, risk factors, the narrow part and the character of the plaque in the comparison of the syndrome of yin and yang have no significant difference, and it is suggested that the type of yin and yang is of universal significance.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3
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，本文編號：2362010
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