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目的:探讨大脑中动脉(middle cerebral artery, MCA)粥样硬化性狭窄处血流动力学与血管重构之间的关系。方法:前瞻性纳入2018年1月至2020年1月期间南京市第一医院神经内科收治的有症状单侧中至重度MCA狭窄患者。所有患者均进行常规MRI及MCA血管壁成像，测量MCA最狭窄处局部血管壁剪应力(wall shear stress, WSS)、跨狭窄处剪应力比值(translesional WSS ratio, WSSR)、跨狭窄处压力比值以及各项斑块参数。根据MCA狭窄处血管重构模式，将患者分为正性重构组和负性重构组，比较两组临床资料以及血管壁和血流动力学参数。应用Pearson相关分析计算血管壁参数与血流动力学参数之间的相关性。结果:共纳入40例有症状单侧MCA中至重度狭窄患者，其中16例存在正性重构，19例存在负性重构。正性重构组急性缺血性卒中患者构成比显著高于负性重构组(68.8%对21.1%；n χ2＝8.069，n P＝0.005)，而其他人口统计学和临床资料均差异无统计学意义。正性重构组MCA狭窄处管腔面积显著小于NR组(n P＝0.004)，斑块面积(n P<0.001)、标准管壁指数(n P＝0.004)、WSSR(n P＝0.004)和WSS(n P＝0.023)显著大于或高于负性重构组。Pearson相关分析显示，狭窄处血管重构指数(n r＝0.376，n P＝0.026)以及斑块面积(n r＝0.407，n P＝0.015)均与WSSR呈显著正相关。n 结论:MCA狭窄处血流动力学与血管重构模式有关，狭窄处斑块面积、WSS和WSSR增大更易引起正性重构。“,”Objective:To investigate the relationship between hemodynamics and vascular remodeling in patients with atherosclerotic middle cerebral artery (MCA) stenosis.Methods:Patients with symptomatic unilateral moderate to severe MCA stenosis admitted to the Department of Neurology, Nanjing First Hospital from January 2018 to January 2020 were enrolled prospectively. All patients underwent conventional MRI and vessel wall imaging of the MCA, and local wall shear stress (WSS) at the most narrowed lumen, translesional WSS ratio (WSSR), translesional pressure ratio, and plaque parameters were measured. The patients were divided into positive remodeling group and negative remodeling group according to the remodeling patterns of stenotic MCA. Pearson correlation analysis was used to calculate the correlation between vascular wall parameters and hemodynamic parameters.Results:A total of 40 patients with symptomatic unilateral MCA moderate to severe stenosis were enrolled, among them, 16 had positive remodeling and 19 had negative remodeling. The proportion of patients with acute ischemic stroke in the positive remodeling group was significantly higher than that in the negative remodeling group (68.8% n vs. 21.1%; n χ2=8.069, n P=0.005), and there were no significant differences in other demographic and clinical data. The lumen area at the MCA stenosis site in the positive remodeling group was significantly smaller than that in the negative remodeling group (n P=0.004). Plaque area (n P<0.001), standard wall index (n P=0.004), WSSR (n P=0.004) and WSS (n P=0.023) in the positive remodeling group were significantly greater or higher than those in the negative remodeling group. Pearson correlation analysis showed that the vascular wall remodeling index (n r=0.376, n P=0.026) and plaque area (n r=0.407, n P=0.015) at the stenosis site were positively correlated with WSSR.n Conclusion:The hemodynamics is associated with remodeling patterns in MCA stenosis. The increased plaque area, WSS and WSSR are more likely to cause positive remodeling in stenotic MCA.