摘要
目的:利用高分辨率核磁共振成像(HR-MRI)技术评价症状性大脑中动脉(MCA)粥样硬化狭窄患者局部血管及斑块特征的性别差异。方法:回顾性收集因MCA供血区缺血事件住院的患者,并依据性别分组,各组内分为症状侧及非症状侧,比较组间及组内HR-MRI图像上获取的局部血管及斑块特征。结果:收集符合纳入及排除标准的患者共71例,其中男性46例(64.7%)。两性最狭窄层面管腔面积存在统计学差异(P=0.039),且性别与侧别间具有明显交互作用(P=0.026);两性狭窄率无明显差异(P=0.056),但该指标的性别与侧别间交互作用明显(P=0.011);男性斑块负荷更大(P=0.006),且性别与健患侧间的交互作用明显(P=0.011);男性斑块强化现象较女性更为常见(P=0.026);多元回归分析提示影响最狭窄管腔面积及斑块负荷的主要因素是高血压及糖尿病,性别主要影响斑块强化(OR 6.75,95%CI1.60-28.49, P=0.009)。结论:症状性MCA粥样硬化患者的局部血管及斑块特征存在性别差异,男性患者斑块体积更大并造成局部血管管腔面积更小,且更易出现易损性斑块。性别因素对局部血管狭窄程度影响不明显,更可能通过影响局部斑块稳定性参与缺血事件的发生。
Objective: To evaluate the gender differences of local vascular and plaque characteristics in patients with symptomatic middle cerebral artery(MCA) atherosclerotic stenosis by high-resolution magnetic resonance imaging(HR-MRI). Methods: We retrospectively collected patients admitted for an ischemic event in the MCA and grouped them according to gender;within each group, the symptomatic and the asymptomatic sides were designated based on the presence or absence of ischemic signs. The local vascular and plaque characteristics acquired from HR-MRI images were compared between the groups and within the symptomatic and asymptomatic divisions of each group. Results: A total of 71 patients were eligible for inclusion and exclusion, including 46 males(64.7%). There was a statistically significant difference in minimum lumen area between male and female patients(P=0.039), and there was a significant correlation between gender and symptomatic sides(P=0.026). There was no significant difference in the stenosis rate between male and female patients(P=0.056), but the correlation between gender and symptomatic sides of this indicator was significant(P=0.011). The male plaque load was greater(P=0.006), and the correlation between the affected sides was significant(P=0.011). Plaque enhancement was more common in males than in females(P=0.026). Multiple regression analysis suggested that the main factors affecting minimum lumen area and plaque burden were hypertension and diabetes, and gender mainly affected plaque enhancement(OR 6.75, 95% CI 1.60-28.49, P=0.009). Conclusion: There are gender differences in local vascular and plaque characteristics in patients with symptomatic MCA atherosclerosis. In male patients, the plaque volume is larger and local vascular lumen area is smaller, and vulnerable plaques are more likely to occur. Gender has no significant effect on the degree of local vascular stenosis, and ischemic events are more likely to be caused by altering the stability of local plaque.
作者
韩柏林
杨静
罗彬
王培福
杜继臣
HAN Bai-lin;YANG Jing;LUO Bin;WANG Pei-fu;DU Ji-chen(Peking University Aerospace School of Clinical Medicine,Beijing 100049,China)
出处
《神经损伤与功能重建》
2019年第12期614-617,629,共5页
Neural Injury and Functional Reconstruction
