颅内动脉粥样硬化斑块形成与血管重构的关系

The Relationship between Intracranial Atherosclerotic Plaque Formation and Vascular Remodeling

目的:研究颅内动脉粥样硬化斑块的形成与血管重构的关系。方法:选择2017年3月到2017年10月在上海市第一人民医院神经内科接受治疗的47例诊断为缺血性脑血管疾病的患者,所有患者发病7天内行头颅核磁共振以及高分辨率核磁共振检查。使用vesselmass软件测量斑块处血管及正常对照处的血管壁面积、流体面积,计算斑块负荷以及血管重构比(RR)。RR>1.05为正向重构,0.95≤RR≤1.05为中间重构,RR<0.95为负向重构。分析大脑中动脉与基底动脉内斑块形成处血管重构情况。根据临床症状以及影像学检查,将斑块分为责任斑块与非责任斑块,比较两组斑块的负荷大小。结果:47例患者中,共有72个斑块,其中责任斑块47个(占65.28%),非责任斑块25个(占34.72%)。位于大脑中动脉的斑块有51个(占70.83%),位于基底动脉的有21个(占29.17%)。大脑中动脉出现负向重构比例较基底动脉更高(47.06%vs. 19.05%,P=0.027),基底动脉出现正向重构比例较大脑中动脉更高(57.14%vs. 25.49%,P=0.010)。相比非责任斑块,责任斑块的斑块负荷更大(0.70±0.08 vs. 0.65±0.07,P=0.017)。结论:颅内动脉在应对斑块形成后出现不同的血管重构模式,负荷更大的斑块更不稳定。

Objective:To investigate the relationship between the formation of intracranial atherosclerotic plaques and vascular remodeling.Methods:47 patients with cerebrovascular ischemic events who were treated in Shanghai General Hospital from March 2017 to October 2017 were analyzed.All patients underwent cranial magnetic resonance imaging and high-resolution magnetic resonance imaging examinations at 3.0 T in seven-days after symptom onset.Lumen area and outer wall area at the lesion and reference sites were measured by using Vesselmass software.Plaque burden and vascular remodeling ratio(RR)were calculated.Vascular remodeling was positive remodeling if RR>1.05,intermediate remodeling if 0.95≤RR≤1.05,and negative remodeling if RR<0.95.The vascular remodeling of middle cerebral artery and basilar artery where plaques existed was analyzed.According to clinical symptoms and imaging examinations,the plaques were divided into culprit and non-culprit plaque,and plaque burdens of the two groups were compared.Results:There were 72 plaques in 47 patients,including 47 culprit plaques(65.28%),25 non-culprit plaques(34.72%),51 plaques existed in the middle cerebral artery(70.83%)and 21 plaques exsited in the basilar artery(29.17%).The middle cerebral artery had a higher proportion to exhibit negative remodeling than basilar artery(47.06%vs.19.05%,P=0.027)and basilar artery had a higher proportion to exhibit positive remodeling than the middle cerebral artery(57.14%vs.25.49%,P=0.010).The plaque burden of culprit plaques was larger than non-culprit plaques(0.70±0.08 vs.0.65±0.07,P=0.017).Conclusion:The intracranial arteries exhibit different vascular remodeling in response to plaque formation,and the plaques with larger plaque burden are more unstable.