基于Essen卒中风险评分的缺血性脑卒中危险度分层的颈动脉斑块特征研究

目的基于Essen卒中风险评分,利用高分辨MR黑血序列及CE-T1WI比较低风险组与高风险组缺血性脑梗死患者颈动脉斑块负荷及成分的差异。材料与方法对2014年1月至2015年12月福建医科大学附属第一医院的41例急性脑梗死患者在发病一周内行颈动脉3D-TOF成像、高分辨MRI黑血序列及CE-T1WI成像,其中低风险组25例,高风险组16例,并对脑梗死的责任颈动脉进行影像分析,比较低风险组及高风险组急性脑梗死患者颈动脉斑块负荷及成分的差异。结果 (1)低风险组与高风险组患者再发脑梗死、年龄、糖尿病、吸烟及周围血管病发生率两组间差异均具有统计学意义。(2)低风险组及高风险组患者的标准化管壁指数、管腔直径、管壁厚度及管腔狭窄率组间差异均有统计学意义(P0.05)。(3)高风险组斑块内纤维帽破裂发生率、出血发生率、脂质坏死核心(lipid-rich necrotic core,LRNC)发生率及管腔狭窄率50%发生率、LRNC面积、LRNC指数及出血面积、出血指数组间差异均有统计学意义(P0.05)。结论低风险组和高风险组缺血性脑梗死患者的颈动脉斑块特征存在差异,利用Essen卒中风险评分结合高分辨MRI可以对缺血性脑卒中危险度进行分层,对具有再发风险的高危患者采取针对性的干预措施,以降低脑卒中再发率。

The study of carotid plaque characteristic of the low risk and high risk of acute ischemic stroke based on essen stroke risk score system

AbstractObjective:To investigate the difference of carotid plaque burden and plaque composition between the low risk and high risk of acute ischemic stroke (AIS) patients based on essen stroke risk score (ESRS).Materials and Methods: Forty-one patients with AIS proved by clinic and follow-up, including low risk AIS (n=25) and high risk AIS (n=16), were enrolled in this retrospective and ethics committee-approved study. Carotid plaque high-resolution MR imaging was performed in all patients, and the responsible carotid arteries were quantitatively and qualitatively analyzed. The carotid plaque burden and compositional features were compared between the low and high risk stroke patients.Results:(1) The prevalence of recurrent AIS, age, diabetes mellitus smoking and peripheral arterial disease in patients with high risk AIS were signiifcantly greater than patients with low risk (allP<0.05). (2) There existed statistical difference between low and high risk AIS patients in normalized wall index (NWI), lumen diameter (LD), wall thickness (WT) and stenosis (allP<0.05). (3) Patients with high risk AIS had a signiifcantly higher prevalence of ifbrous cap rupture (FCR), intra-plaque hemorrhage (IPH) compared, lipid rich necrotic core (LRNC) and lumen stenosis>50% with those with low risk AIS (bothP<0.05). The LRNC area, LRNC index, IPH area and IPH index in high risk AIS patients was statistically higher than that in low (allP<0.05).Conclusion:There existed some differences between low risk and high risk AIS patients, and ESRS combined with carotid plaque high-resolution MR imaging will be helpful for the stratiifcation study for AIS patients.