糖尿病患者颈动脉斑块磁共振成像特征与急性脑缺血病灶形态关系研究

摘要

目的 探讨2型糖尿病患者颈动脉斑块磁共振成像(magnetic resonance imaging,MRI)特征与相应供血区急性脑缺血病灶形态的关系.方法 横断面研究,入组临床急性颈内动脉供血区缺血性卒中患者,排除心源性卒中,在发病一周内行颈动脉磁共振管壁成像(magnetic resonance vessel wall imaging,MR-VWI)检查和常规MRI[包括磁共振血管成像(magnetic resonance angiography,MRA)和弥散加权成像(diffusion-weighted imaging, DWI)]检查,评估症状侧颈动脉斑块负荷和成分特征以及颅内外动脉管腔狭窄度,根据DWI上梗死灶形态对急性脑缺血病灶形态和体积进行分析.结果 共入选140例急性缺血性卒中患者,其中68例(48.6%)为2型糖尿病患者,多因素回归分析显示2型糖尿病是症状侧颈动脉斑块富脂质核发生的独立危险因素[比值比(odds ratio,OR)3.35,95%可信区间(confidence interval,CI)1.33~8.43];在兼具富脂质核斑块的患者中,2型糖尿病组颈内动脉区域急性脑缺血病灶体积[(15.45±8.97)ml vs(9.09±8.64)ml,P=0.011]和大穿支动脉梗死发生率[34.0% vs 13.2%,P=0.024)]显著高于非糖尿病组.结论 颈动脉供血区急性缺血性卒中患者中,2型糖尿病与症状侧颈动脉动脉粥样硬化斑块MRI特征,尤其是富脂质核密切相关,且更易发生大穿支动脉的梗死,提示MR-VWI细致化分析结合糖尿病因素有助于临床对缺血性卒中风险的分层和个体化诊治.%Objective This study aimed to investigate the correlation between the carotid plaque magnetic resonance imaging (MRI) characteristics and acute cerebral infarction focus features in patients with type 2 diabetes mellitus (DM). Methods It was a cross section study. Patients with acute cerebrovascular syndrome in internal carotid artery territory were recruited and the cardiogenic factors were excluded. All patients underwent both carotid and brain MRI scans including magnetic resonance angiography (MRA) and diffusion-weighted imaging (DWI) within 1 week of symptom onset. Ipsilateral carotid plaque morphological and compositional characteristics intracranial and extracranial carotid arteries stenosis were also determined. Acute cerebral infarction patterns and size were evaluated on DWI. Results Of the 140 patients been recruited, 68 (48.6%) patients had DM. The multivariate analysis showed that DM was found to be an independent risk factor for the presence of lipi-rich necrotic core (LRNC) plaque [odds ratio (OR) 3.35, 95% confidence interval (CI) 1.33-8.43], and type 2 DM patients exhibited higher prevalence of carotid type IV-VI lesions, larger plaque burden as well as larger lipid-rich necrotic core plaques compared with non-DM patients. Among the patients with carotid LRNC plaque on symptomatic side, larger acute cerebral infarction size and more concomitant large perforating artery infarct patterns in the internal carotid artery territory were found in DM group than those of non-DM group[(15.45±8.97)ml vs(9.09±8.64)ml,P=0.011;34.0% vs 13.2%, P=0.024]. Conclusion This study shows that more concomitant large perforating artery infarct patterns in the internal carotid artery territory are found in the type 2 DM patients with ipsilateral carotid plaque features, particularly the LRNC, than those of non-DM patients. Quantification of the carotid plaque characteristics by MRI combined DM has the potential usefulness for stroke risk stratification and individualized diagnosis and treatment.