CAJ | 학술논문

目的：评估缺血性卒中患者颅内供血动脉硬化斑块的强化特征，分析责任血管斑块强化程度与时间推移及血清超敏C-反应蛋白（ hs-CRP）浓度的相关性。方法回顾性分析2010年3月至2013年4月来院住院缺血性卒中患者81例颅内责任血管的管壁特征。所有患者均进行3.0 T MR常规卒中方案扫描及斑块高分辨率MRI（ HR-MRI）。根据卒中症状发生至HR-MRI检查间隔，分为早期组58例（间隔＜4周）、中期组13例（间隔为4～12周）、晚期组10例（间隔＞12周）。分析责任血管的管壁特征、斑块强化程度，测量血清hs-CRP的浓度。采用多组秩和检验（ Kruskal-Wallis H检验）比较3组间斑块强化程度及血清hs-CRP差别，血清hs-CRP浓度以中位数（上下四分位数）表示；采用Spearman等级相关分析症状发生后时间及hs-CRP与强化程度之间的关系。结果81例患者中，55例硬化性斑块位于大脑中动脉M1段，26例位于基底动脉。早期组斑块明显强化29例、轻度强化25例、未见强化4例；中期组对应的例数分别为4、6、3例；晚期组对应的例数分别为0、4、6例；3组间斑块强化程度之间的差别具有统计学意义（H＝16.934，P＜0.01）。随着时间的推移，强化的发生率及程度减低，二者呈明显负相关关系（ r＝-0.792， P ＜0.01）。早期、中期及晚期3组患者血清hs-CRP浓度分别为7.0（3.0，13.0）、2.3（1.0，3.0）及1.9（0.5，4.0）mg/L，3组间差别具有统计学意义（ H＝14.345， P ＜0.01）。血清 hs-CRP 浓度随时间的推移呈递减趋势，二者呈负相关（ r ＝-0.357，P＜0.01），与斑块强化程度呈正相关关系（r＝0.526，P＜0.01）。结论 HR-MRI增强扫描能清晰显示颅内动脉硬化斑块的强化，可作为颅内动脉硬化斑块炎症反应的标志，对斑块破裂及继发的缺血性脑卒中风险评估具有重要价值。
목적：평고결혈성졸중환자로내공혈동맥경화반괴적강화특정，분석책임혈관반괴강화정도여시간추이급혈청초민C-반응단백（ hs-CRP）농도적상관성。방법회고성분석2010년3월지2013년4월래원주원결혈성졸중환자81례로내책임혈관적관벽특정。소유환자균진행3.0 T MR상규졸중방안소묘급반괴고분변솔MRI（ HR-MRI）。근거졸중증상발생지HR-MRI검사간격，분위조기조58례（간격＜4주）、중기조13례（간격위4～12주）、만기조10례（간격＞12주）。분석책임혈관적관벽특정、반괴강화정도，측량혈청hs-CRP적농도。채용다조질화검험（ Kruskal-Wallis H검험）비교3조간반괴강화정도급혈청hs-CRP차별，혈청hs-CRP농도이중위수（상하사분위수）표시；채용Spearman등급상관분석증상발생후시간급hs-CRP여강화정도지간적관계。결과81례환자중，55례경화성반괴위우대뇌중동맥M1단，26례위우기저동맥。조기조반괴명현강화29례、경도강화25례、미견강화4례；중기조대응적례수분별위4、6、3례；만기조대응적례수분별위0、4、6례；3조간반괴강화정도지간적차별구유통계학의의（H＝16.934，P＜0.01）。수착시간적추이，강화적발생솔급정도감저，이자정명현부상관관계（ r＝-0.792， P ＜0.01）。조기、중기급만기3조환자혈청hs-CRP농도분별위7.0（3.0，13.0）、2.3（1.0，3.0）급1.9（0.5，4.0）mg/L，3조간차별구유통계학의의（ H＝14.345， P ＜0.01）。혈청 hs-CRP 농도수시간적추이정체감추세，이자정부상관（ r ＝-0.357，P＜0.01），여반괴강화정도정정상관관계（r＝0.526，P＜0.01）。결론 HR-MRI증강소묘능청석현시로내동맥경화반괴적강화，가작위로내동맥경화반괴염증반응적표지，대반괴파렬급계발적결혈성뇌졸중풍험평고구유중요개치。
Objective To assess the enhancement feature of intracranial atherosclerotic plaque in the vessel supplying the territory of infarction by using high-resolution MR imaging.To analyze the correlation between the degree of plaque enhancement , time elapsed and the concentration of hypersensitive C-reactive protein ( hs-CRP ).Methods The characteristics of vessel walls and intracranial vascular stenoses were retrospectively analyzed in 81 patients with ischemic strokes.All subjects were imaged with a traditional stroke MR protocol and HR-MRI scanning for plaque on a 3.0 T MRI scanner.According to the elapsed time between infarct and MR examination , all cases were classified into early stage (<4 weeks from acute stroke, n=58), middle stage (4-12 weeks, n=13) and late stage ( >12 weeks, n=10).The characteristics of vessel walls and degrees of enhancement of atherosclerotic plaques were assessed and the concentrations of hs-CRP in all patients were determined.The Kruskal-Wallis H test was used to compare the degree of enhancement and hs-CRP concentration among the early , middle and late stage.The concentration of hs-CRP was presented as median ( interquartile range ).The Spearman correlation was used to analyze the correlation between elapsed time , hs-CRP concentration and degree of enhancement.Results Fifty-five (55/81) plaques were located at the M1 segments, and the other 26 (26/81) plaques were at the basilar artery.The degree and presence of enhancement from strong to none were 29, 25 and 4 in the early stage;4, 6 and 3 in the middle stage and 0, 4, 6 in the late stage, respectively.The degree and presence of enhancement were significantly different among them (H=16.934,P<0.01).There was a remarkable trend of decreasing degree and presence of enhancement of the atherosclerotic plaque relative to increasing time after the ischemic event(r=-0.792,P<0.01).The serum hs-CRP concentration for early, middle and late stage were 7.0(3.0, 13.0), 2.27(1.0, 3.03) and 1.88(0.50, 4.0)mg/L (H=14.345,P<0.01) , respectively.There was a trend of decreasing hs-CRP concentration relative to the time elapsed ( r =-0.357,P<0.01).The degrees of enhancement of the plaques were parallel to the levels of hs -CRP( r=0.526,P<0.01).Conclusions Enhanced HR-MRI scanning may clearly demonstrate the enhancement characteristics of intracranial atherosclerotic plaques as an indicator of inflammation.It might play an important role to detect risk factors for intracranial plaque rupture and subsequent acute ischemic stroke .