无症状性基底动脉粥样硬化患者动脉重塑临床研究

Clinical research of arterial remodeling of asymptomatic basilar atherosclerosis

目的探究无症状性基底动脉粥样硬化的动脉重塑特征。方法回顾性分析北京协和医院2014年8月至2016年12月前瞻性建立的高分辨磁共振数据库,将基底动脉存在无症状性动脉粥样硬化性斑块的人群和基底动脉正常且未发生供血区缺血性卒中者进行对照研究。采用3D CUBE T1WI成像方法,测量并比较分析两组人群的斑块和管壁特征,包括管周面积、管腔面积、最大管壁厚度和基底动脉直径。结果研究共纳入无症状性基底动脉病变组46例和对照组55例。缩窄性重塑是无症状性基底动脉粥样硬化斑块的主要形式,占55.1%。1例患者的基底动脉可见缩窄性重塑斑块和扩张性重塑斑块共存。与扩张性重塑斑块相比,缩窄性重塑斑块的狭窄率更大(P<0.01),重塑指数、管周面积、管腔面积、管壁面积和基底动脉直径更小(P均<0.01)。与对照组相比,无症状性基底动脉病变组的基底动脉管周面积和直径差异均无统计学意义(P=0.246,P=0.137),而管壁面积(P<0.01)和最大管壁厚度(P<0.01)更大,管腔面积更小(P<0.01)。结论无症状性基底动脉粥样硬化存在以缩窄性重塑为主的局灶性重塑,但不存在累及血管走行全程的普遍性重塑。

Objective The remodeling of asymptomatic basilar atherosclerosis Background and objective： The remodeling mode of asymptomatic basilar atherosclerosis remains unclear. We aimed to investigate its characteristic. Methods We analyzed the HRMRI database built prospectively in Peking Union Medical College Hospital （from August 2014 to December 2016） retrospectively. Comparisons were made between patients with asymptomatic atherosclerotic plaques in basilar artery and those with normal basilar artery and without ischemic stroke in its territory. 3D CUBE T1WI was used to analyze and measure plaque and vessel wall characteristics, including vessel area, lumen area, maximal wall thickness, and basilar artery diameter. Results Forty-six patients were enrolled as asymptomatic basilar atherosclerotic group, while fifty-five patients as control group in our study. Negative remodeling is more frequently observed in asymptomatic basilar atherosclerosis plaques （55.1%）. There was only one patient whose basilar artery had plaques with both negative remodeling and positive remodeling. Compared with positive remodeling, negative remodeling often contained larger stenosis degree（P〈0.01） and smaller remodeling ratio, vessel area, lumen area, wall area and basilar artery diameter （P〈0.01, P〈0.01, P=0.021, P〈0.01, P〈0.01）. As to vessel area and basilar artery diameter, there was no significant difference between asymptomatic basilar atherosclerotic group and control group（P=0.246; P=0.137）. However, asymptomatic basilar atherosclerotic group had larger wall area （P〈0.01）, maximal wall thickness （P〈0.01）and smaller lumen area（P〈0.01）. Conclusion Negative remodeling is frequently observed in asymptomatic basilar plaques. In patients with asymptomatic basilar atherosclerosis, general remodeling ofbasilar artery doesn＇t exist.