大脑中动脉粥样硬化斑块与单发性皮质下梗死的相关性

Correlation between middle cerebral artery atherosclerotic plaques and single subcorfical infarction

目的应用高分辨率磁共振成像（high resolution magnetic resonance imaging，HR-MRI）探讨大脑中动脉（middlecerebralartery，MCA）粥样硬化斑块与单发性皮质下梗死（single subcortical infarction，SSI）的相关性。方法对2012年1月至2014年11月期间接受梗死灶同侧MCA水平段狭窄部位HR—MRI检查的SSI患者进行回顾性分析，分成近端SSI（proximalSSI，pSSI）和远端SSI（distalSSI，dSSI），分别记录两组不同类型梗死模式的梗死灶纵径、横径、体积以及MCA深穿支载体动脉的管腔狭窄程度、斑块分布、斑块是否强化、脑白质病变以及一般资料。结果共纳入78例SSI患者，pSSI组40例（51％），dSSI组38例（49％）。dSSI组Fazekes3级白质病变（63．5％对40．0％；χ2=4．183，P=0．041）和脑深部白质病变（50．0％对15．0％；χ2=10．961，P=0．001）的比例显著高于pSSI组。pSSI组MCA斑块位于开口（35．0％对13．2％；χ2=3．930，P=0．047）、斑块位于血管后上壁（42．5％对21．4％；χ2=9．491，P〈0．001）和强化斑块（87．5％对30．0％；χ2=25．447，P〈0．001）的比例以及管腔狭窄程度[（60．38±10．20）％对（45．00±6．44）％；t=3．625，P=0．031]均显著高于dSSI组。此外，pSSI组的梗死灶纵径、横径和体积均显著大于dSSI组（P均〈0．001）。多变量logistic回归分析显示，病变同侧MCA强化斑块[优势比（oddsratio，OR）11．764，95％可信区间（confidenceinterval，CI）2．081～66．511；P=0．005]、斑块位于血管后上壁（OR6．131，95％CI1．012～23．339；P=0．037）与pSSI独立相关，而深部白质病变（DR0．280，95％C10．203～0．648；P=0．012）与dSSI独立相关。结论pSSI组和dSSI组都普遍存在MCA深穿支载体粥样硬化斑块，pSSI主要与深穿支载体动脉粥样硬化斑块部位和强化斑块相关，而dSSI主要与深穿支动脉病变相关。

Objective To investigate the correlation between middle cerebral artery （MCA） atherosclerotic plaques and single subcortical infarction （SSI） using high-resolution magnetic resonance imaging （HR-MRI）. Methods The patients with SSI received HR-MRI examinations at the ipsilateral MCA horizontal segment stenosis from January 2012 to November 2014 were analyzed prospectively. They were divided into proximal SSI （pSSI） and distal SSI （dSSI）. The longitudinal and transverse diameters and volume of different types of infarction pattern as well as the degree of luminal stenosis of MCA deep perforating parent artery, plaque distribution, plaque enhancement or not, white matter lesions, and general information of both groups were documented respectively. Results A total of 78 patients with SSI were enrolled, including 40 （51% ） in the pSSI group and 38 （49%） in the dSSI group. The proportions of Fazekas scale grade 3 white matter lesions （63.5%vs. 40. 0% ; χ2 = 4. 183, P = 0. 041 ） and deep white matter lesions （50. 0% vs. 15.0% ;χ2 = 10. 961, P =0. 001） in the dSSI group were significantly higher than those in the pSSI group.The proportions of MCA plaque in the opening （35.0% vs. 13.2%; χ2 = 3.930, P= 0.047）, plaque enhancement （87.5% vs. 30. 0% ; χ2 = 25. 447, P 〈 0. 001 ） and posterosuperior wall plaques （42.5% vs. 21.4%;χ2 =9.491, P〈0.001） and the degree of luminal stenosis （60.38%± 10.20% vs. 45.00% ± 6.44% ; t =3. 625, P =0. 031） in the pSSI group were all significantly higher than those in the dSSI group. In addition, the longitudinal and transverse diameters and volume of the infarcts in the pSSI group were significantly larger than those in the dSSI group （all P 〈 0. 001）. Multivariate logistic regression analysis showed that MCA enhanced plaques on the lesion ipsilateral sides （odds ratioE ORI 11. 764, 95% confidence intervall CI] 2. 081 - 66. 511 ; P = 0. 005） and posterosuperior wall plaques （OR 6. 131, 95% CI 1. 012 - 23. 339; P =0. 037） were independently associated with pSSI, while deep white matter lesions （OR O. 280, 95% CI 0.203- 0.648; P= 0.012） was independently associated with dSSI. Conclusions The atherosclerotic plaques of MCA deep perforating parent artery are common in both the pSSI group and the dSSI group, pSSI is mainly associated with the location of atherosclerotic plaques of deep perforating parent artery and enhanced plaques, while dSSI is mainly associated with deep perforating artery vasculopathy.