狭窄性大脑中动脉斑块高信号与正性重塑的并存对脑梗死发病机制的影响

Hyperintense plaque coexisting with positive remodeling in stenotic middle cerebral artery may be associated with cerebral infarction mechanism

目的探讨基于单侧前循环脑梗死人群的颅内动脉粥样硬化斑块易损特征与脑梗死亚型之间的关系。方法回顾分析2018年12月至2020年12月在北部战区总医院诊治并完成头颅高分辨磁共振成像的首发急性单侧前循环大动脉粥样硬化型脑梗死患者,最终纳入58例符合纳入排除标准的患者。根据脑梗死亚型,患者被分为动脉-动脉栓塞组(32例)及非动脉-动脉栓塞组(26例),收集两组患者的基线数据、高信号斑块、重塑类型及斑块表面不规则的存在及象限分布。采用多因素Logistic回归分析探讨斑块易损特征与脑梗死亚型之间的关系,而高信号斑块与重塑类型之间对梗死机制的交互影响被进一步用桑基图来可视化呈现。结果在多因素分析中,高信号斑块(OR=3.90,95%CI 1.21~12.59,P=0.023)和动脉重塑类型(与无重塑比较,正性重塑的OR=4.32,95%CI 0.86~21.49,趋势检验P=0.027)是动脉-动脉栓塞机制的两个强独立预测因素。重要的是,高信号斑块与正性重塑共存时,可以进一步协同促进动脉-动脉栓塞事件的发生(Wald=10.04,P交互=0.007)。此外,受试者工作特征曲线分析结果,也进一步证实正性重塑的高信号斑块对于动脉-动脉栓塞的事件发生有着最强的分辨力(曲线下面积:0.710,95%CI 0.576~0.845,P=0.006)。结论在急性前循环动脉粥样硬化型脑梗死患者中,颅内高信号斑块与正性重塑共存时,可以协同促进动脉-动脉栓塞事件发生。这对于理解不同梗死机制发生以及二级预防策略制定和治疗靶点选择,都有着重要意义。

Objective To investigate the association between plaque vulnerability characteristics and infarction sub-types in patients with acute unilateral anterior circulation cerebral infarction due to intracranial atherosclerotic disease.Methods A total of 58 eligible patients who underwent intracranial high-resolution magnetic resonance imaging(HRMRI)were finally enrolled in the retrospective study from December 2018 to December 2020.In the current study,all patients were classified into the group with artery-to-artery(A-to-A)embolic infarction(n=32)and the group without(n=26),according to infarction sub-types on diffusion-weighted imaging.Baseline information,the presence/absence of hyperintense plaque,irregular plaque surface,remodeling pattern and quadrant distribution by HRMRI were collected and evaluated.Multivariate Logistic regression analysis was performed to determine the relationship between plaque vulnerability and infarction sub-types.Furthermore,the analysis of interaction between hyperintense plaque and positive remodeling in response to A-to-A embolism was visualized by Sankey diagram.Results The presence of hyperintense plaque(OR=3.90,95%CI 1.21-12.59,P=0.023)and arterial remodeling patterns(positive remodeling vs intermediate state,OR=4.32,95%CI 0.86-21.49,P for trend=0.027)were the strong independent predictors for A-to-A embolism.Importantly,a significantly positive synergy between the remodeling pattern and hyperintense plaque in response to infarction sub-types was found by Sankey diagram(Wald=10.044,P for interaction=0.007).Similarly,in receiver operating characteristic curve analysis,the discrimination of hyperintense plaque combined with positive remodeling for A-to-A embolism was significantly superior to that of either biomarker alone(area under the curve=0.710,95%CI 0.576-0.845,P=0.006).Conclusion A synergistic effect between positive remodeling and hyperintense plaque can promote plaque vulnerability,suggesting a potential target sub-population may benefit from stroke prevention with intensive antithrombotic therapy,although this must be confirmed in future.