MRI多序列检测脑梗死合并糖尿病患者颈动脉粥样硬化斑块稳定性的研究

目的采用MRI多序列检查方法评估脑梗死合并糖尿病患者颈动脉粥样硬化斑块的稳定性,并分析影响斑块稳定性的因素。方法前瞻性纳入经超声检查证实有颈动脉粥样硬化斑块的急性脑梗死患者63例,分为糖尿病组30例,非糖尿病组33例。行颈部MRI多序列检查(包括三维时间飞跃法(3D-TOF)成像、T1加权像、T2加权像、血管壁质子密度加权成像(PDWI)。根据MRI检查定义斑块的易损性,比较两组斑块的稳定性及斑块大小。采用多因素Logistic回归分析法分析影响颈动脉斑块稳定性的因素。结果 (1)126支(63例)颈动脉中,91支有斑块。糖尿病组41支(30例),其中36支(87.8%)为易损斑块;非糖尿病组50支(33例),其中19支(38.0%)为易损斑块。两组易损斑块发生率差异有统计学意义(P0.01)。(2)两组斑块大小比较,糖尿病组斑块最大厚度为(5.8±0.8)mm,非糖尿病组为(5.2±1.3)mm,差异有统计学意义(P0.05)。血管总面积、管壁面积、管腔面积及管壁标准化指数比较,两组差异无统计学意义(P0.05)。(3)多因素Logistic回归分析显示,糖尿病(OR=20.780,95%CI:4.531~95.217,P=0.000)、饮酒史(OR=13.518,95%CI:1.086~168.265,P=0.043)为影响颈动脉粥样硬化斑块稳定性的独立危险因素。女性为斑块稳定性的保护性因素(OR=0.096,95%CI:013~0.069,P=0.020)结论颈部MRI多序列检查是检测脑梗死患者颈部动脉斑块稳定性的有效方法。脑梗死合并糖尿病患者颈动脉粥样硬化斑块稳定性较非糖尿病患者差。

Carotid atherosclerotic plaque stability detected with multiple sequence MRI in patients with cerebral infarction and diabetes mellitus

Objective To evaluate the carotid atherosclerotic plaque stability using multiple- sequence MRI in patients with cerebral infarction and diabetes mellitus, and to analyze the factors affecting plaque stability. Methods A total of 63 patients with acute cerebral infarction and carotid atherosclerotic plaques confirmed by ultrasound examination were enrolled in the study. They were divided into either a diabetes mellitus group （n = 30） or a non-diabetes mellitus group （n = 33）. All the patients were received multiple-sequence MRI （including three-dimensional time-of-flight 3D-TOF], T1- and T2-weighted imaging, and proton density weighted imaging PDWI ] ）. The plaque vulnerability was defined according to the MRI examinations. The stability and size of plaques were compared between the two groups. Multivariate logistic regression analysis was used to analyze the factors affecting the stability of carotid plaque. Results （ 1 ） Of the 126 carotid arteries in patients 63, 91 had plaques. There were 41 carotid arteries in the diabetes mellitus group （n = 30）, and 36 （87.8%） of them were vulnerable plaques. There were 50 carotid arteries in the non-diabetes mellitus group （ n = 33 ）, and 19 （38.0%） of them werevulnerable plaques. There was significant difference in the incidence of vulnerable plaque between the two groups （P 〈 0. O1 ）. （2）The size of plaque was compared between the two groups. The maximum thickness of the plaque in the diabetes mellitus group was 5.77- 0.77 mm, and that in the non-diabetes mellitus group was 5.18 - 1.34 mm. There was significant difference （ P 〈 0.05 ）. There were no significant differences in the total area of blood vessel, vascular wall area, and lumen area between the two groups （P 〉 0.05 ）. （ 3 ） Multivariate logistic regression analysis showed that diabetes mellitus （ OR = 20. 780, 95% CI 4.531 -95. 217,P = 0.000） and history of alcohol consumption （ OR = 13. 518, 95% CI 1. 086 - 168. 265,P = 0.043 ） were the independent risk factors for affecting carotid atheroselerotic plaque stability. The female sex were the protective factor for plaque stability （ OR = 0. 096, 95% CI O. 013 -0. 069, P = 0. 020）. Conclusion Multiple sequence MRI is an effective method for detecting carotid artery plaque stability in patients with cerebral infarction. The carotid atherosclerotie plaque stability in cerebral infarction patients with diabetes mellitus is even poor than those without diabetes mellitus