摘要
目的 探究急性缺血性脑卒中患者脑白质微观结构特征及其与侧支循环的关系。方法 选取2023年1月至2024年5月贵阳市第二人民医院收治的150例急性缺血性脑卒中患者作为研究对象,另选择同期健康志愿者150例作为对照人群,比较两组一般临床资料。所有受试者均经头颅MR检查,提取脑白质微观结构特征,分析脑白质微观结构特征与脑白质病变的相关性。依据侧支循环形成状态将150例急性缺血性脑卒中患者分为侧支循环良好组(n=91)和侧支循环不良组(n=59),比较两组患者的一般临床资料和脑白质微观结构特征,通过ROC曲线分析脑白质微观结构特征对卒中、脑白质病变、侧支循环不良的预测价值。结果 比较健康组和卒中组一般资料可知,两组患者在吸烟史、高血脂史、高血压史、LDL-C、HDL-C、FIB、D-D之间存在显著差异(均P<0.05);健康组和卒中组各向异性分数(FA)值差异有统计学意义的脑白质纤维束有:小脑中脚、脑桥交叉束、胼胝体部,穹窿柱及穹窿体、右皮质脊髓束、左皮质脊髓束、右小脑下脚、左小脑下脚、右前放射冠、左前放射冠;健康组和卒中组平均扩散量(MD)值差异有统计学意义的脑白质纤维束有:小脑中脚、脑桥交叉束、右小脑上脚、左小脑上脚、右外囊、左外囊、右额枕上束;健康组和卒中组径向扩散量(RD)值差异有统计学意义的脑白质纤维束有:小脑中脚、脑桥交叉束、左侧皮质脊髓束、右小脑下脚、左小脑下脚、右小脑上脚、左小脑上脚、右外囊及左外囊;健康组和卒中组轴向扩散量(AD)值差异有统计学意义的脑白质纤维束有:小脑中脚、右侧内侧丘系、左侧内侧丘系、右小脑上脚、左小脑上脚、右丘脑后辐射、左丘脑后辐射、右矢状层、右外囊、左外囊、右扣带及左扣带。相关性分析显示,小脑中脚、脑桥交叉束、胼胝体部,穹窿柱及穹窿体、右皮质脊髓束、左皮质脊髓束、右小脑下脚、左小脑下脚、右前放射冠、左前放射冠的FA值与脑白质病变评分均呈显著负相关关系(均P<0.05);小脑中脚、脑桥交叉束、右小脑上脚、左小脑上脚、右外囊、左外囊、右额枕上束的MD值与脑白质病变评分均呈显著正相关关系(均P<0.05);小脑中脚、脑桥交叉束、左侧皮质脊髓束、右小脑下脚、左小脑下脚、右小脑上脚、左小脑上脚、右外囊及左外囊的RD值与脑白质病变评分均呈显著正相关关系(均P<0.05);小脑中脚、右小脑上脚、左小脑上脚、右外囊、左外囊的AD值与脑白质病变评分均呈显著正相关关系(均P<0.05),右内侧丘系、左内侧丘系、右丘脑后辐射、左丘脑后辐射、右矢状层、右扣带、左扣带的AD值与脑白质病变评分均呈显著负相关关系(均P<0.05)。比较侧支循环良好组和侧支循环不良组一般资料可知,两组患者在脑白质病变评分之间存在显著差异(P<0.05)。侧支循环不良组患者小脑中脚的FA值显著低于侧支循环良好组,MD值、RD值和AD值均显著高于侧支循环良好组,其他纤维束两组之间无显著差异。ROC分析提示小脑中脚FA、MD、RD、AD值对卒中、脑白质损伤、侧支循环不良均具有良好的预测价值,四者联合诊断的效能均高于各值单独诊断效能。结论 急性缺血性脑卒中患者的脑白质微观结构存在不同程度的损伤,小脑中脚白质FA值、MD值、AD值、RD值变化可用于鉴别侧支循环状态,且四者联合诊断效能更佳。
ObjectiveTo explore the microstructural characteristics of white matter in patients with acute ischemic and their relationship with collateral circulation,Methods In all,150 patients with acute ischemic stroke admitted to our tal from January 2023 to May 2024 were selected as the study subjects,and another 150 healthy volunteers during the same peri-od were selected as the control group to compare the general clinical data of the two groups.All subjects underwent head MRI examination to extract microstructural features of brain white matter and analyze the correlation between microstructural fea-tures of brain white matter and brain white matter lesions.According to the formation status of collateral circulation,150 pa-tients with acute ischemic stroke were divided into good collateral circulation group(n=91)and poor collateral circulation group(n=59).The general clinical data and microstructure characteristics of white matter were compared between the two groups.The predictive value of microstructure characteristics of white matter for stroke,white matter lesions,and poor collater-al circulation were analyzed using ROC curves,Results Comparing the general information between the healthy group and the stroke group,it could be seen that there were significant differences between the two groups in terms of smoking history,hyper-lipidemia history,hypertension history,LDL-C,HDL-C,FIB,and D-D(all P<0.O5);The brain white matter fiber bundles with statistically significant FA values in the healthy and stroke groups included:cerebellar peduncle,pontine chiasmatic tract,corpus callosum,fornix column and fornix body,right corticospinal tract,left corticospinal tract,right cerebellar peduncle,left cerebellar peduncle,right anterior radial crown,and left anterior radial crown;The brain white matter fiber bundles with statistically sig-nificant MD values in the healthy and stroke groups included:cerebellar peduncle,pontine chiasmatic tract,right cerebellar pe-duncle,left cerebellar peduncle,right external capsule,left external capsule,and right frontal occipital bundle;The brain white matter fiber bundles with statistically significant RD values in the healthy and stroke groups included:cerebellar peduncle,pon-tine chiasmatic tract,left corticospinal tract,right cerebellar peduncle,left cerebellar peduncle,right cerebellar peduncle,left cer-ebellar peduncle,right external capsule,and left external capsule;The brain white matter fiber bundles with statistically signifi-cant AD values in the healthy and stroke groups included:midcerebellar peduncle,right medial thalamus,left medial thalamus,right superior cerebellar peduncle,left superior cerebellar peduncle,right posterior thalamic radiation,right sagittal layer,right external capsule,left external capsule,right cingulate and left cingulate.Correlation analysis showed that the FA values of the cerebellar peduncle,pontine chiasmatic tract,corpus callosum,fornix column and fornix body,right corticospinal tract,left corti-cospinal tract,right cerebellar peduncle,left cerebellar peduncle,right anterior radial crown,and left anterior radial crown were significantly negatively correlated with the white matter lesion score(all P<0.05);The MD values of the cerebellar peduncle,pontine chiasmatic tract,right cerebellar peduncle,left cerebellar peduncle,right external capsule,left external capsule,and right frontal occipital tract were significantly positively correlated with the white matter lesion score(all P<0.05);The RD values of the cerebellar peduncle,pontine chiasmatic tract,left corticospinal tract,right cerebellar peduncle,left cerebellar peduncle,right cerebellar peduncle,left cerebellar peduncle,right external capsule,and left external capsule were significantly positively correla-ted with the white matter lesion score(all P<0.05);The AD values of the cerebellar peduncle,right cerebellar peduncle,left cerebellar peduncle,right external capsule,and left external capsule were significantly positively correlated with the white matter lesion score(all P<0.05),while the AD values of the right medial thalamus,left medial thalamus,right posterior thalamus radi-ation,right sagittal layer,right cingulate and left cingulate were significantly negatively correlated with the white matter lesion score(all P<0.05).Comparing the general information between good collateral circulation group and poor collateral circulation group,it could be seen that there was a significant difference in the white matter lesion score between the two groups of patients(P<0.05).The ROC analysis showed that FA,MD,RD,and AD values in the cerebellar midfoot had good predictive value for stroke,white matter injury,and collateral circulation disorders,and the combined diagnostic efficacy of the four values was high-er than the diagnostic efficacy of each value alone.Conclusion The microstructure of white matter in patients with acute ische-mic stroke exhibits varying degrees of damage.Changes in FA,MD,AD,and RD values in the white matter of the cerebellar pe-duncle can be used to differentiate collateral circulation status,and the combined diagnostic efficacy of the four is better.
作者
张永义
付蓉
刘娟
赵晶
Zhang Yongyi;Fu Rong;Liu Juan(Department of Neurology,the Fourth People's Hospital of Guiyang,Guiyang 550007,China;Department of Neurology,the Second People's Hospital of Guiyang/Jinyang Hospital Affiliated to Guizhou Medical University,Guiyang 550081,China)
出处
《华中科技大学学报(医学版)》
北大核心
2025年第4期523-534,共12页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
基金
贵州省卫生健康委员会科学技术基金项目(No.gzwkj2024-300)。
关键词
缺血性脑卒中
脑白质
微观结构
侧支循环
散张量成像
ischemic stroke
white matter
microscopic structure
collateral circulation
scattering tensor imaging
