摘要
目的采用高分辨率磁共振血管壁成像评估大脑中动脉狭窄患者斑块特征与支架术后再狭窄的关系。方法纳入2019年1月至2023年3月就诊于承德医学院附属医院的有症状动脉粥样硬化性大脑中动脉狭窄患者66例。均在支架植入术前完成高分辨率磁共振血管壁成像检查。依据术后影像学随访分为支架内再狭窄组与支架内未狭窄组。比较两组术前影像学评估斑块特征。结果支架内再狭窄组14例,支架内未狭窄组52例。斑块分布多位于下侧壁(37.8%)和腹侧壁(28.7%),两组差异无统计学意义(P>0.05)。相较于支架内未狭窄组,支架内再狭窄组负性重构(64.2%比28.8%)更高,差异有统计学意义(χ^(2)=6.026,P=0.049);支架内再狭窄组斑块负荷79.09±8.82,支架内未狭窄组为69.46±10.49,差异有统计学意义(t=3.143,P=0.003);支架内再狭窄组同型半胱氨酸偏高为(16.02±4.24)mol/L,支架内未狭窄组为(12.05±3.34)mol/L,差异有统计学意义(t=3.717,P<0.001)。支架内再狭窄组中明显强化斑块更多(78.5%比42.3%),差异有统计学意义(χ^(2)=6.311,P=0.043)。多因素logistic回归分析显示,斑块负荷(OR=1.225,95%CI:1.040~1.443,P=0.015)与同型半胱氨酸(OR=1.676,95%CI:1.150~2.442,P=0.007)是支架内再狭窄的独立危险因素。ROC曲线分析显示,斑块负荷预测支架内再狭窄的AUC=0.765,95%CI:0.622~0.908,P=0.002,特异度0.731,灵敏度0.714;同型半胱氨酸AUC=0.767,95%CI:0.623~0.911,P=0.002,特异度0.942,灵敏度0.500;两者联合的预测效能最佳,AUC=0.887,95%CI:0.794~0.981,P<0.001,特异度0.904,灵敏度0.714。结论斑块负荷和同型半胱氨酸预测支架内再狭窄具有较高的特异度与灵敏度。
Objective By using high-resolution magnetic resonance angiography to display the vascular wall imaging so as to evaluate the relationship between plaque characteristics and postoperative in-stent restenosis(ISR)in patients with middle cerebral artery stenosis.Methods A total of 66 patients with symptomatic atherosclerotic middle cerebral artery stenosis,who were admitted to the Affiliated Hospital of Chengde Medical College of China from January 2019 to March 2023,were enrolled in this study.Before stent implantation,all the 66 patients completed high-resolution magnetic resonance angiography.According to the postoperative imaging follow-up results,the patients were divided into ISR group and non-ISR group.The preoperative plaque characteristics,which were assessed by high-resolution magnetic resonance imaging,were compared between the two groups.Results ISR group had 14 patients and non-ISR group had 52 patients.Most of the plaques were located in the inferior lateral wall(37.8%)and the ventral lateral wall(28.7%),in which no statistically significant difference existed between the two groups(P>0.05).Compared with non-ISR group,in ISR group the negative remodeling degree was obviously higher and the difference between the two groups was statistically significant(χ^(2)=6.026,P=0.049).The plaque load in ISR group and non-ISR group was 79.09±8.82 and 69.46±10.49 respectively,and the difference between the two groups was statistically significant(t=3.143,P=0.003).The homocysteine level in ISR group and non-ISR group was(16.02±4.24)mol/L and(12.05±3.34)mol/L respectively,and the difference between the two groups was statistically significant(t=3.717,P<0.001).In ISR group,there were more significantly contrast-enhanced plaques(78.5%vs.42.3%),with statistically significant difference(χ^(2)=6.311,P=0.043).Multivariate logistic regression analysis showed that plaque load(OR=1.225,95%CI:1.040-1.443,P=0.015)and homocysteine level(OR=1.676,95%CI:1.150-2.442,P=0.007)were the independent risk factors for ISR.ROC curve analysis showed that in predicting ISR,the AUC,specificity and sensitivity of the plaque load were 0.765(95%CI:0.622-0.908,P=0.002),0.731 and 0.714 respectively,which of the homocysteine level were 0.767(95%CI:0.623-0.911,P=0.002),0.942 and 0.500 respectively.The combination use of plaque load and homocysteine level could achieve the best predictive effect,its AUC,specificity and sensitivity were 0.887(95%CI:0.794-0.981,P<0.001),0.904 and 0.714 respectively.Conclusion The plaque load assessed by high-resolution magnetic resonance imaging and the homocysteine level have higher specificity and sensitivity in predicting ISR in patients with middle cerebral artery stenosis.
作者
龚宇
于淼
田甜
张继伟
胡军
崔志新
白雪东
韩凤伟
褚会松
王占森
呼铁民
GONG Yu;YU Miao;TIAN Tian;ZHANG Jiwei;HU Jun;CUI Zhixin;BAI Xuedong;HAN Fengwei;CHU Huisong;WANG Zhansen;HU Tiemin(Department of Neurosurgery,Affiliated Hospital of Chengde Medical College,Chengde,Hebei Province 067000,China)
出处
《介入放射学杂志》
CSCD
北大核心
2024年第12期1282-1287,共6页
Journal of Interventional Radiology
基金
河北省政府资助临床医学优秀人才培养项目(ZF2024235)
承德市科学技术研究与发展计划项目(202006A086)。
关键词
高分辨率磁共振血管壁成像
大脑中动脉狭窄
动脉粥样硬化斑块
支架内再狭窄
high-resolution magnetic resonance vascular wall imaging
middle cerebral artery stenosis
atherosclerotic plaque
in-stent restenosis
