基于临床及高分辨率血管壁MRI分析颈部动脉夹层患者发生急性缺血性脑卒中危险因素

Risk factors of acute ischemic stroke in patients with cervical artery dissection:Analysis based on clinical and high-resolution MR vessel wall imaging

目的基于临床及高分辨率血管壁MRI(HRMR-VWI)分析颈部动脉夹层(CAD)患者发生急性缺血性脑卒中(AIS)的危险因素。方法回顾性分析48例经头颈动脉HRMR-VWI诊断的CAD患者,观察其头部弥散加权成像,将27例梗死灶位于夹层血管供血区域者纳入AIS组,其余21例纳入非AIS组。采用单因素及多因素logistic回归分析评估CAD患者发生AIS的临床及HRMR-VWI相关危险因素。结果组间男性、糖尿病及HRMR-VWI显示双腔征、腔内血栓占比,以及管壁强化程度、管腔狭窄程度差异均有统计学意义(P均<0.05)。男性、糖尿病、HRMR-VWI显示双腔征、腔内血栓、管壁2级强化及管腔重度狭窄/闭塞是CAD患者发生AIS的危险因素(P均<0.05)。男性(OR=8.77)、糖尿病(OR=21.01)及HRMR-VWI显示管壁2级强化(OR=4.21)均为CAD患者发生AIS的独立危险因素(P均<0.05)。结论男性、糖尿病及HRMR-VWI显示管壁2级强化均为CAD患者发生AIS的独立危险因素。

Objective To analyze the risk factors of acute ischemic stroke(AIS)in patients with cervical artery dissection(CAD)based on clinical and high-resolution MR vessel wall imaging(HRMR-VWI).Methods Data of 48 patients with CAD diagnosed with head and carotid artery HRMR-VWI were retrospectively analyzed.Head diffusion weighted imaging was performed,and 27 patients with infarctions located in the blood supply area of the dissection vessel were enrolled in AIS group,while the rest 21 were enrolled in non-AIS group.Univariate and multivariate logistic regression analysis were used to evaluate the risk factors related to clinical and HRMR-VWI manifestations of AIS in CAD patients.Results Significant differences of proportion of male,diabetes,double lumen sign and intraluminal thrombi,also of wall enhancement degrees and lumen stenosis degrees on HRMR-VWI were found between groups(all P<0.05).Male,diabetes,double lumen sign,intraluminal thrombus,wall enhancement of grade 2 and severe lumen stenosis/occlusion shown on HRMR-VWI were all risk factors of AIS,while male(OR=8.77),diabetes(OR=21.01)and grade 2 wall enhancement showed on HRMR-VWI(OR=4.21)were all independent risk factors of AIS in CAD patients(all P<0.05).Conclusion Male,diabetes and grade 2 wall enhancement showed on HRMR-VWI were independent risk factors of AIS in CAD patients.