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目的应用颈动脉高分辨磁共振黑血成像(MR-BBI)技术,探讨脑卒中患者糖化血红蛋白(HbA1c)水平与颈动脉易损斑块特征以及脑梗死严重程度之间的关系。方法 153名急性颈内动脉供血区脑卒中患者被分为高HbA1c组(≥6.5%)及低HbA1c组(<6.5%),所有的患者均在发病1周内完成颈动脉MR-BBI及头颅常规MRI,定量分析责任侧颈动脉粥样硬化病变参数(管腔狭窄率、斑块负荷和成分)和相应供血区急性脑梗死(ACI)病灶分布及大小。结果与低HbA1c组患者比较,高HbA1c组患者具有更大的斑块负荷以及大坏死脂核斑块发生率。高HbA1c水平是颈动脉斑块发生以及坏死脂核发生的独立危险因素,优势比(OR)分别为3.71及7.08。在同时存在颈内动脉供血区ACI及颈动脉斑块的患者中,HbA1c水平与ACI大小存在相关性。结论在急性颈内动脉供血区脑卒中患者中,高水平HbA1c与责任侧颈动脉易损斑块特征尤其是大坏死脂核密切相关,可能有助于预测ACI的严重程度。
Objective To evaluate the relationship between the level of HbA1c in carotid artery and the vulnerable plaque of cerebral artery and the severity of cerebral infarction by MR-BBI. Methods A total of 153 stroke patients with acute carotid artery blood supply were divided into high HbA1c group (≥6.5%) and low HbA1c group (6.5%). All patients completed MR-BBI and cranial Routine MRI was used to quantitatively analyze lesion parameters (stenosis rate, plaque load and components) and the distribution and size of focal infarct (ACI) lesions in the corresponding donor side. Results Compared with patients with low HbA1c, patients with high HbA1c had a greater plaque load and a higher incidence of macular necrosis. High HbA1c levels were an independent risk factor for the occurrence of carotid plaque and the production of necrotic liponuclear lean (OR) of 3.71 and 7.08, respectively. In patients with both ACI and carotid artery plaque in both internal carotid artery supply areas, there was a correlation between HbA1c levels and ACI size. Conclusions In stroke patients with acute internal carotid artery supply, high level of HbA1c may be closely related to the vulnerable plaque characteristics of the responsible carotid artery, especially the macula necrosis. It may be helpful to predict the severity of ACI.