症状性颈动脉粥样硬化斑块与缺血性卒中后短期mRS评分的相关性

The correlation between symptomatic carotid atherosclerotic plaques and short-term mRS score after ischemic stroke

目的 使用高分辨磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging,HR-VWI)检查分析症状性颈动脉粥样硬化斑块构成与首次发生缺血性卒中患者进行卒中二级预防3个月后mRS评分的相关性,为此类患者的预后评价提供理论依据。材料与方法 2022年11月至2023年6月,在石河子大学第一附属医院招募出现缺血性卒中症状并在症状侧存在颈动脉粥样硬化斑块的患者。将其中符合纳入及排除标准且完成了3个月卒中二级预防的患者连续入组本研究并进行改良Rankin量表(modified Rankin Scale,mRS)评分,根据mRS评分将入组患者分为不良预后组(mRS≥2)和良好预后组(mRS<2)。比较两组患者的临床数据、首次HR-VWI检查的斑块成分和卒中二级预防3个月后的斑块成分。分析斑块中不同成分与mRS评分的相关性。结果 共计入组66例(不良预后组39例,良好预后组27例),两组患者的临床资料差异无统计学意义(P>0.05)。首次检查中,不良预后组含有斑块内出血的比例高于良好预后组(P<0.05),良好预后组斑块内存在钙化的比例以及钙化体积均大于不良预后组(P<0.05);卒中二级预防3个月后,不良预后组和良好预后组间含有斑块内出血的比例无明显差异(P>0.05),良好预后组中斑块内存在钙化的比例更大、钙化体积更大(P<0.05)。结论 症状性颈动脉粥样硬化斑块中的钙化及钙化体积与首次发生缺血性卒中患者进行卒中二级预防3个月后mRS评分具有相关性;症状初期行HR-VWI检查可对因颈动脉粥样硬化斑块发生缺血性卒中患者的预后评价提供理论依据。

Objective:High resolution magnetic resonance vessel wall imaging(HR-VWI)was used to analyze the correlation between the composition of symptomatic carotid atherosclerotic plaque and the mRS score three months after secondary prevention of stroke in patients with first ischemic stroke,so as to provide a theoretical basis for the prognosis evaluation of such patients.Materials and Methods:From November 2022 to June 2023,patients with ischemic stroke symptoms and carotid atherosclerotic plaque on the symptomatic side were recruited in the First Affiliated Hospital of Shihezi University.Patients who meet the inclusion and exclusion criteria and have completed secondary stroke prevention for 3 months will be continuously enrolled in this study and will receive a modified Rankin Scale(mRS)score.Based on the mRS score,the enrolled patients will be divided into a poor prognosis group(mRS≥2)and a good prognosis group(mRS<2).Compare the clinical data,plaque composition on the first HR-VWI examination,and plaque composition three months after secondary stroke prevention between two groups of patients.Analyzing the correlation between different components in plaques and mRS scores.Results:A total of 66 patients were included in the group(39 in the poor prognosis group and 27 in the good prognosis group),and there was no statistically significant difference in clinical data between the two groups(P>0.05).In the first examination,the proportion of plaque bleeding in the poor prognosis group was higher than that in the good prognosis group(P<0.05),and the proportion and volume of calcification in plaques in the good prognosis group were higher than those in the poor prognosis group(P<0.05);After 3 months of secondary prevention of stroke,there was no significant difference in the proportion of plaque bleeding between the poor prognosis group and the good prognosis group(P>0.05),while the good prognosis group had a larger proportion and volume of calcification in plaques(P<0.05).Conclusions:The calcification and calcification volume in symptomatic carotid atherosclerotic plaques were correlated with the mRS score 3 months after secondary prevention of stroke in patients with first ischemic stroke;HR-VWI at the initial stage of symptoms can provide a theoretical basis for the prognosis evaluation of ischemic stroke patients due to carotid atherosclerotic plaque.