症状性大脑中动脉狭窄斑块分布与中国卒中亚型相关性研究

摘要/Abstract

摘要：

目的观察症状性大脑中动脉（middle cerebral artery，MCA）狭窄患者狭窄段血管动脉粥样硬化斑块分布特点及其与中国缺血性卒中分型（Chinese Ischemic Stroke Subclassification，CISS）中缺血性卒中发病机制的关系。方法采用前瞻性研究方法，连续收集大脑中动脉狭窄所致初发缺血性卒中患者，依据高分辨率磁共振成像（high-resolution magnetic resonance imaging，HRMRI）所显示的动脉粥样硬化斑块分布的位置将患者分为上壁组、下壁组、腹侧组、背侧组，比较不同象限斑块分布引起缺血性卒中的机制是否存在差异。结果 HRMRI能够清楚地显示大脑中动脉管壁结构，入组27例患者中腹侧斑块10（37.03%）例，背侧斑块3（11.11%）例，上壁斑块7（25.93%）例，下壁斑块7（25.93%）例。男性患者动脉粥样硬化斑块常见于腹侧，女性患者动脉粥样硬化斑块常见于背侧。上壁组动脉粥样硬化斑块堵塞穿支动脉病变6例（85.7%），下壁组穿支病变1例（14.3%），腹侧组穿支病变0例（0%），背侧组穿支病变3例（100%），差异有显著性（P <0.001）。结论本组症状性大脑中动脉狭窄患者中动脉粥样硬化斑块多发生于动脉腹侧，与穿支动脉开口相对；上壁和背侧斑块易堵塞穿支动脉开口而引起缺血性事件。

文章导读： 通过高分辨率磁共振血管壁成像研究，显示症状性大脑中动脉狭窄患者责任动脉粥样硬化斑块的位置与患者脑缺血的机制有关。

关键词: 高分辨率磁共振成像; 动脉粥样硬化斑块; 中国缺血性卒中分型; 缺血性卒中

Abstract:

Objective To observe the relationship between the distribution of atherosclerotic plaque in symptomatic middle cerebral artery stenosis and Chinese Ischemic Stroke Subtype (CISS type). Methods Prospective method was used. Primary cerebral infarction patients caused by cerebral artery stenosis were collected continuously. And high-resolution magnetic resonance imaging (HRMRI) examination was conducted on them. According to the distribution of plaque, these patients were divided into superior wall group, inferior wall group, ventral group and dorsal group to compare whether there were differences in cerebral infarction mechanism caused by the distribution of different plaques. Results HRMRI could clearly show the structure of the vascular wall. Among 27 enrolled patients, 10 (37.03%) patients were with ventral plaques, 3 (11.11%) were with dorsal plaques, 7 (25.93%) were with superior wall plaques and 7 (25.93%) were with inferior wall plaques. For men, atherosclerotic plaques were commonly seen in the ventral part, and for women, in the dorsal part. Six patients had perforating branch lesion in the superior wall group, 1 had perforating branch lesion in the inferior wall group, none had perforating branch lesion in the ventral group and 3 had perforating branch lesion in the dorsal group. Differences were statistically significant (P<0.001). Conclusion The atherosclerotic plaques of patients with symptomatic middle cerebral artery stenosis more frequently occur in the ventral part of the artery, facing toward perforating branch artery ostia; Dorsal plaques and inferior wall plaques are easy to block the openings of the perforating artery, thus causing ischemic events. The distribution of cerebral artery plaque is related to stroke subtype.

Key words: High-resolution magnetic resonance imaging; Atherosclerotic plaque; Chinese Ischemic Stroke Subclassification; Ischemic stroke

陈静1，李欣2，马梦华3，王海平3，曹亦宾2. 症状性大脑中动脉狭窄斑块分布与中国卒中亚型相关性研究[J]. 中国卒中杂志, 2015, 10(03): 212-217.

CHEN Jing*, LI Xin,MA Meng-Hua, WANG Hai-Ping, CAO Yi-Bin.. Research on the Correlation between the Distribution of Plaque in Symptomatic Middle
Cerebral Artery Stenosis and Chinese Ischemic Stroke Subtype[J]. Chinese Journal of Stroke, 2015, 10(03): 212-217.

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