高分辨MRI观察复发脑梗死患者颅内动脉粥样硬化斑块及其危险因素

目的 以高分辨MRI（HR-MRI）观察初发脑梗死（PCI）与复发脑梗死（RCI）颅内动脉粥样硬化斑块特征，并分析RCI危险因素。方法 收集75例大脑中动脉或基底动脉狭窄并接受HR-MR检查的脑梗死患者，根据既往有无脑梗死病史分为PCI组（n=41）和RCI组（n=34），比较2组动脉粥样硬化斑块HR-MRI特征及临床资料，并分析脑RCI危险因素。结果 RCI组吸烟史占比、同型半胱氨酸（HCY）及尿酸（UA）水平高于PCI组（P均<0.05），组间其余临床资料及实验室结果差异无统计学意义（P均>0.05）。HR-MRI示RCI组责任血管重度狭窄占比及斑块负荷高于PCI组，斑块较易出现T2WI、T1WI高信号，且强化程度高（P均<0.05）。Logistic回归分析结果显示斑块T2WI高信号、管腔重度狭窄、高HCY及高UA均为RCI的危险因素（P均<0.05）。结论 RCI的HR-MRI表现具有一定特征性，斑块呈T2WI高信号及管腔重度狭窄为脑梗死复发危险因素；联合临床相关危险因素有助于对患者进行分层管理。

High resolution MRI observation on intracranial atherosclerotic plaque and risk factors in patients with recurrent cerebral infarction

Objective To observe the characteristics of primary cerebral infarction (PCI) and recurrent cerebral infarction (RCI) with high-resolution MRI(HR-MRI), and to analyze the risk factors of RCI. Methods Seventy-five patients with cerebral infarction attributed to stenosis of the middle cerebral artery or basilar artery who underwent HR-MRI were divided into PCI group (n=41) and RCI group (n=34) according to the previous history of cerebral infarction. The clinical data and HR-MRI characteristics of atherosclerotic plaque were compared between 2 groups, and the risk factors of RCI were analyzed. Results The proportion of patients with smoking behavior as well as homocysteine (HCY) and uric acid (UA) levels in RCI group were all higher than those in PCI group (all P<0.05), while there was no statistical difference of other clinical features nor laboratory results between groups (all P>0.05). HR-MRI showed that the proportion of severe responsible vascular stenosis and plaque burden in RCI group were larger than those in PCI group, and plaques were more prone to appear with high signals on T2WI and T1WI and higher enhancement (all P<0.05). Logistic regression analysis results showed that higher signal on T2WI in plaque, severe lumen stenosis and high levels of HCY and UA were risk factors for RCI (all P<0.05). Conclusion HR-MRI angiography of RCI had certain characteristics. High signals of plaque on T2WI and severe lumen stenosis were risk factors for RCI. Combining with related clinical risk factors could contribute to the stratified patient management.