陈露萍;孙家元;杨志勇;张芾;朱蓓;蒋艺兰;

• 1:如皋市人民医院

摘要(Abstract)：

目的分析MRI在糖尿病合并急性脑梗死动脉粥样硬化患者斑块分布情况检测应用中的有效性,并分析影响斑块稳定性的相关因素。材料与方法回顾性分析本院2018年1月至2020年1月收治的急性脑梗死且颈动脉粥样硬化斑块患者92例,其中单纯性急性脑梗死动脉粥样硬化患者34例,糖尿病合并急性脑梗死动脉粥样硬化患者58例。对比两组患者血管面积、斑块厚度、斑块长度、最狭窄处血管面积与狭窄率评估斑块分布情况,分析影响斑块稳定性的因素,包括高血压、高血脂、冠心病、饮酒史、性别和糖尿病等。结果 92例患者两侧出现斑块动脉数量为148支,单纯性急性脑梗死动脉粥样硬化组62支,合并糖尿病足86支。男性92支(46例),女性56支(28例),男性斑块率83.64%(46/55),女性斑块率75.68%(28/37),两组对比差异有统计学意义(P=0.013,t=6.872);其中单纯硬化组易损斑块比例70.97%(44/62),合并糖尿病组易损斑块比例83.72%(72/86),两组对比差异有统计学意义(P=0.001,t=7.671)。对照组(单纯组)梗死部位血管面积、斑块厚度、斑块长度、最狭窄处血管面积与狭窄率分别为(11.73±1.16) mm2、(1.17±0.18) mm、(5.73±0.62) mm、(1.63±0.32) mm2和(76.43±17.52)%,观察组(合并组)梗死部位血管面积、斑块厚度、斑块长度、最狭窄处血管面积与狭窄率分别为(12.15±1.18) mm2、(1.34±0.17) mm、(6.83±0.69) mm、(1.14±0.35)mm2和(82.78±13.80)%。男性患者梗死部位血管面积、斑块厚度、斑块长度、最狭窄处血管面积与狭窄率分别为(11.86±1.25) mm2、(1.12±0.17) mm、(5.72±0.83)mm、(1.43±0.25)mm2和(82.35±9.72)%,女性患者梗死部位血管面积、斑块厚度、斑块长度、最狭窄处血管面积与狭窄率分别为(11.53±1.28) mm2、(1.09±0.16)mm、(5.52±0.85)mm、(1.69±0.24)mm2和(81.87±9.82)%。合并组患者血管狭窄程度高于单纯组,男性患者血管狭窄程度高于女性患者,差异有统计学意义(P<0.05)。冠心病、高血脂症、高血压、饮酒史、糖尿病、抽烟史和体重指数(body mass index,BMI)过高为影响斑块稳定性差,女性为斑块稳定性高。结论 MRI技术可作为评估糖尿病合并急性脑梗死动脉粥样硬化患者斑块稳定性的有效手段,合并糖尿病患者斑块长度、斑块厚度、血管狭窄率和梗死面积高于单纯急性脑梗死动脉粥样硬化患者,男性患者斑块长度、斑块厚度、血管狭窄率和梗死面积高于女性患者。冠心病、高血压、糖尿病和抽烟等因素会加重急性脑梗动脉粥样硬化患者病情,应当注重生活习惯,合理控制致病因素。

关键词(KeyWords)： 磁共振成像;糖尿病;急性脑梗死;动脉粥样硬化;斑块

Abstract:

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作者(Author): 陈露萍;孙家元;杨志勇;张芾;朱蓓;蒋艺兰;

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参考文献(References)：

• [1]Jin Y.Application of magnetic resonance imaging to assess the stability of carotid atherosclerotic plaque in patients with cerebral infarction and diabetes and analysis of related risk factors.Chin Health Care Nutrition,2017,27(1):272-273.DOI:10.3969/j.issn.1004-7484.2017.01.395.靳勇.应用磁共振成像评估脑梗死合并糖尿病患者颈动脉粥样硬化斑块稳定性及相关危险因素分析.中国保健营养,2017,27(1):272-273.DOI:10.3969/j.issn.1004-7484.2017.01.395.
• [2]Zhang WJ,Zhu T,Zhang Y,et al.The correlation between vascular endothelial function and infarct type and carotid plaque properties in patients with acute cerebral infarction.Progress in Modern Biomedicine,2016,16(30):5886-5889.DOI:10.13241/j.cnki.pmb.2016.30.022.张文静,朱涛,张永,等.血管内皮功能与急性脑梗死患者梗死类型及颈动脉斑块性质的相关性.现代生物医学进展,2016,16(30):5886-5889.DOI:10.13241/j.cnki.pmb.2016.30.022.
• [3]Zhang BM.The application value of combined CT and magnetic resonance imaging in the early diagnosis of acute cerebral infarction.JPract Med Imaging,2018,19(3):274-276.DOI:10.16106/j.cnki.cn14-1281/r.2018.03.037.张保民.急性脑梗死早期诊断中CT与磁共振成像联合检查的应用价值.实用医学影像杂志,2018,19(3):274-276.DOI:10.16106/j.cnki.cn14-1281/r.2018.03.037.
• [4]Zhao JH.Research on type 2 diabetes with cerebral infarction based on nuclear magnetic resonance metabolomics.Diabetes New World,2015(9):65-65.DOI:10.3969/j.issn.1672-4062.2015.09.049.赵军华.基于核磁共振代谢组学对2型糖尿病合并脑梗死的研究.糖尿病新世界,2015(9):65-65.DOI:10.3969/j.issn.1672-4062.2015.09.049.
• [5]Wang QK,Jiang ZH,Xu Z,et al.Study on the correlation between serum fatty acid binding protein 4 expression and clinical prognosis in patients with acute cerebral infarction combined with type 2 diabetes.World Complex Med,2019,5(8):13-17.DOI:10.11966/j.issn.2095-994X.2019.05.08.05.王全奎,蒋子贺,徐铮,等.急性脑梗死合并2型糖尿病患者血清脂肪酸结合蛋白4的表达与临床预后的相关性研究.世界复合医学,2019,5(8):13-17.DOI:10.11966/j.issn.2095-994X.2019.05.08.05.
• [6]Shang WW,Dong AD,Zhang YY.LRNC features of carotid plaque can diagnose the risk of acute cerebral infarction in patients with type2 diabetes.Genomics and Applied Biology,2019,38(3):1375-1382.DOI:10.13417/j.gab.038.001375.尚文文,董安定,张迎云.颈动脉斑块LRNC特征可诊断2型糖尿病患者急性脑梗死的风险.基因组学与应用生物学,2019,38(3):1375-1382.DOI:10.13417/j.gab.038.001375.
• [7]He DQ,Wen HF,Jin D,et al.Independent predictors of cerebral infarction in patients with diabetes complicated with transient ischemic attack.Stroke Nervo Dis,2019,26(1):68-72.DOI:10.3969/j.issn.1007-0478.2019.01.016.贺大权,温宏峰,金迪,等.糖尿病合并短暂性脑缺血发作患者发展为脑梗死的独立预测因素.卒中与神经疾病,2019,26(1):68-72.DOI:10.3969/j.issn.1007-0478.2019.01.016.
• [8]Li J,Zhao W,Liu Y,et al.Evaluation value of MRI on the stability of carotid atherosclerotic plaque in patients with diabetic acute cerebral infarction.Progress in Modern Biomedicine,2016,16(13):2541-2543,2592.DOI:10.13241/j.cnki.pmb.2016.13.038.李晶,赵武,刘影,等.MRI对糖尿病急性脑梗死患者颈动脉粥样硬化斑块稳定性的评估价值.现代生物医学进展,2016,16(13):2541-2543,2592.DOI:10.13241/j.cnki.pmb.2016.13.038.
• [9]Xia PF,Wang W,Zou L,et al.Analysis of risk factors for the formation of microcerebral infarction after interventional operation of intracranial unruptured aneurysm.Stroke Nervo Dis,2017,24(6):508-511.DOI:10.3969/j.issn.1007-0478.2017.06.007.夏鹏飞,王伟,邹亮,等.颅内未破裂动脉瘤介入术后微小脑梗死灶形成的危险因素分析.卒中与神经疾病,2017,24(6):508-511.DOI:10.3969/j.issn.1007-0478.2017.06.007.
• [10]Xu PC,Gao ZL,Wang L,et al.The clinical significance of FLAIRintravascular hyperintensity in acute posterior circulation multiple cerebral infarction.J Apoplexy&Nervous Dis,2016,33(7):604-607.DOI:10.19845/j.cnki.zfysjjbzz.2016.07.007.徐鹏程,高宗良,王龙,等.FLAIR血管内高信号在急性后循环多发性脑梗死中的临床意义.中风与神经疾病杂志,2016,33(7):604-607.DOI:10.19845/j.cnki.zfysjjbzz.2016.07.007.
• [11]Peng ZH,You Y.The relationship between the overall burden of cerebral small vessel disease and intracranial macrovascular disease in patients with acute cerebral infarction and its influencing factors.JShaoyang Univ(Natural Sci Edit),2018,15(2):97-103.DOI:10.3969/j.issn.1672-7010.2018.02.016.彭志辉,游咏.急性脑梗死患者脑小血管病总体负担与颅内大血管病变的关系及影响因素研究.邵阳学院学报(自然科学版),2018,15(2):97-103.DOI:10.3969/j.issn.1672-7010.2018.02.016.
• [12]Zheng H,Dong JL.Discussion on the effect of blood glucose fluctuation on vascular endothelial injury in patients with type 2 diabetes (T2DM)combined with acute cerebral infarction (ACI).Chin Med Guide,2019,17(31):154-155.DOI:10.15912/j.cnki.gocm.2019.31.120.郑慧,董建立.2型糖尿病(T2DM)合并急性脑梗死(ACI)患者血糖波动对血管内皮损伤的影响探讨.中国医药指南,2019,17(31):154-155.DOI:10.15912/j.cnki.gocm.2019.31.120.
• [13]Zhu FM.To explore the effect of blood sugar control status before the onset of cerebral infarction on the early prognosis of patients with acute cerebral infarction combined with diabetes.Heilongjiang Med,2019,44(9):1079-1080.DOI:10.3969/j.issn.1004-5775.2019.09.036.朱芳梅.探讨脑梗死发病前血糖控制状态对合并糖尿病的急性脑梗死患者早期预后的影响.黑龙江医学,2019,44(9):1079-1080.DOI:10.3969/j.issn.1004-5775.2019.09.036.
• [14]Zheng XQ,Zhou ZS.MRI imaging characteristics of brain small vessel disease in type 2 diabetes patients.New World of Diabetes,2018,21(24):34-35.DOI:10.16658/j.cnki.1672-4062.2018.24.034.郑许强,周振寿.2型糖尿病患者脑部小血管病变的MRI成像特点研究.糖尿病新世界,2018,21(24):34-35.DOI:10.16658/j.cnki.1672-4062.2018.24.034.
• [15]Wu CR,Zhang RZ,Liang YY,et al.Analysis of diagnostic efficacy and curative effect assessment value of CT and MRI for atherosclerosis.Panminerva Medica,2019,61(4):449-456.DOI:10.23736/S0031-0808.19.03742-X.
• [16]Wu JY,Xin JM,Yang XF,et al.Deep morphology aided diagnosis network for segmentation of carotid artery vessel wall and diagnosis of carotid atherosclerosis on black-blood vessel wall MRI.Med Physics,2019,46(12):5544-5561.DOI:10.1002/mp.13739.
• [17]Deep morphology aided diagnosis network for segmentation of carotid artery vessel wall and diagnosis of carotid atherosclerosis on black-blood vessel wall MRI.Med Phys,2020,47(6):5544-5561.DOI:10.1002/mp.14092.
• [18]Ozair R,Michael M,Pallavi B,et al.Reproducibility and changes in vena caval blood flow by using 4D flow MRI in pulmonary emphysema and chronic obstructive pulmonary disease (COPD):The multi-ethnic study of atherosclerosis (MESA) COPD substudy.Radiology,2019,292(3):585-594.DOI:10.1148/radiol.2019182143.
• [19]Rahman O,Markl M,Balte P,et al.Reproducibility and changes in vena caval blood flow by using 4D flow MRI in pulmonary emphysema and chronic obstructive pulmonary disease (COPD):The multi-ethnic study of atherosclerosis (MESA) COPD substudy.Int J Med Radiol,2019,42(6):726.DOI:10.19300/j.2019.r0905.
• [20]Li L,Wang JH,Wu ML,et al.Macrophage-targeted and clearable glutathione-based MRI nanoprobes for atherosclerosis molecular imaging.J Nanoparticle Res,2019,21(11):231.DOI:10.1007/s11051-019-4688-x.
• [21]Nadine KB,Richard K,John E,et al.Left ventricular mass at MRIand long-term risk of cardiovascular events:The multi-ethnic study of atherosclerosis(MESA).Radiology,2019,293(1):107-114.DOI:10.1148/radiol.2019182871.