急性颈内动脉系统脑梗死患者颈内动脉角与动脉粥样硬化斑块形态关系的研究

doi:10.3969/j.issn.1673-5765.2019.07.008

摘要/Abstract

摘要：

目的利用颈动脉高分辨率磁共振成像（high resolution MRI，HR-MRI）技术分析急性脑梗死患者颈内动脉角（internal carotid artery angle，ICAA）与动脉粥样硬化斑块形态学特点，探讨ICAA与动脉粥样硬化斑块形态的关系。方法入组2011年11月-2012年6月的急性颈内动脉系统脑梗死患者，行颈动脉HR-MRI 检查，获得每例患者左右侧ICAA及动脉粥样硬化斑块形态资料。根据ICAA大小的中位数将颈动脉分为ICAA≥35°组和ICAA＜35°组，比较两组血管颈动脉粥样硬化斑块发生率和斑块特点。分别以左右侧颈动脉粥样硬化各斑块成分总量为因变量，对其可能的影响因素进行多因素回归分析。结果共有86例患者的162支颈动脉图像纳入最终分析，其中ICAA≥35°组78支，ICAA＜35°组84支， ICAA≥35°组动脉粥样硬化斑块检出率[72支（92.3%）vs 47支（56.0%），P＜0.01]及易损斑块检出率 [34支（43.6%）vs 13支（15.5%），P =0.03）]均较ICAA＜35°组高，差异有统计学意义。ICAA≥35°组动脉粥样硬化斑块中富含脂质坏死核心[59支（75.6%）vs 31支（36.9%），P <0.01）]及斑块内出血[（21 支（26.9%）vs 10支（11.9%），P =0.02）]的检出率高。回归分析显示，年龄是左侧颈动脉粥样硬化斑块钙化成分总量（B 0.35，95%CI 0.21～1.65，P =0.01）及右侧颈动脉粥样硬化斑块斑块内出血成分总量（B 0.34，95%CI 0.30～2.32，P =0.01）的危险因素，ICAA非平面角（B 0.37，95%CI 1.23～7.33，P =0.01）是左侧颈动脉粥样硬化斑块富含脂质坏死核心成分总量的危险因素，颈外动脉非平面角（B 0.33， 95%CI 0.20～2.07，P =0.02）是右侧颈动脉粥样硬化斑块钙化成分总量的危险因素。结论随着ICAA角度增大，动脉粥样硬化斑块的检出率呈上升趋势，ICAA大者易损动脉粥样硬化斑块的检出率也高。ICAA对动脉粥样硬化斑块各成分的含量有影响。ICAA与颈动脉粥样硬化斑块的发生有关，但并非是颈动脉粥样硬化发生的独立危险因素。

文章导读： 本研究通过血管影像学对颈动脉分叉处几何学形态与颈动脉粥样硬化斑块的发生和特点的关系进行了分析，结果显示颈内动脉角大的患者更发生颈动脉粥样硬化斑块，但斑块的不同成分的含量和斑块的易损性不单纯与颈内动脉角有关。

关键词: 脑梗死; 高分辨率磁共振成像; 颈动脉角

Abstract:

Objective To investigate the relationship between internal carotid artery angle (ICAA) and internal carotid artery (ICA) plaque morphology in patients with acute anterior circulation infarction using high resolution magnetic resonance imaging (HR-MRI). Methods Patients with acute anterior circulation infarction admitted to Beijing Tian Tan Hospital from November 2011 to June 2012 were enrolled in this study. All patients underwent HR-MRI examination to obtain ICAA and plaque morphology data. According to the median of ICAA, all patients were divided into ICAA ≥35° and <35° groups, and the amounts and characteristics of carotid atherosclerotic plaques between the two groups were compared. Multi-factor logistic regression analysis was performed to analyze the influencing factors of bilateral ICA plaques morphology. Results A total of 162 ICA images from 86 patients were included in the final analysis, with 78 vessels in ICAA ≥35° group and 84 vessels in ICAA <35° group. The detection rate of ICA plaques [92.3% (72/78) vs 56.0% (47/84), P <0.01] and vulnerable plaques [43.6% (34/78) vs 15.5% (13/84), P =0.03] in ICAA ≥35° group were both higher than that in ICAA <35° group, with statistical difference. The detection rate of lipid-rich necrotic core plaques [75.6% (59/78) vs 36.9% (31/84), P <0.01] and intraplaque hemorrhage [26.9% (21/78) vs 11.9% (10/84), P =0.02] were higher in ICAA ≥35° group than that in ICAA <35° group. Linear regression analysis showed that age was an independent risk factor of plaque calcification volume on the left side (B 0.35, 95%CI 0.21- 1.65, P =0.01) and intra-plaque hemorrhage volume on the right side (B 0.34, 95%CI 0.30-2.32, P =0.01), and the non-plane angle of ICAA was an independent risk factor of lipid-rich necrotic core volume in the plaques on the left side (B 0.37, 95%CI 1.23-7.33, P =0.01), and the non-plane angle of external carotid artery was a risk factor of plaque calcification volume on the right side (B 0.33, 95%CI 0.20-2.07, P =0.02). Conclusions With the increasing of ICA angle, the amount of plaques as well as vulnerable plaques increased. ICAA was associated with the components and amount of carotid plaques, while it was not an independent risk factor for carotid atherosclerosis.

Key words: Cerebral infarction; High resolution magnetic resonance imaging; Carotid artery angle

王琳，王晶，申园，龚浠平，刘艳芳. 急性颈内动脉系统脑梗死患者颈内动脉角与动脉粥样硬化斑块形态关系的研究[J]. 中国卒中杂志, 2019, 14(07): 671-676.

WANG Lin, WANG Jing, SHEN Yuan, GONG Xi-Ping, LIU Yan-Fang. Relationship between Internal Carotid Artery Angle and Plaque Morphology in Patients with Acute Anterior Circulation Infarction[J]. Chinese Journal of Stroke, 2019, 14(07): 671-676.

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