【作者】 王雨刚；

【导师】 邵国富；

【作者基本信息】 苏州大学 ， 神经病学， 2012， 硕士

【摘要】 第一部分缺血性脑卒中患者脑动脉CTA结果分析目的：拟通过对缺血性脑卒中患者的脑动脉CTA检查结果进行分析，了解颅内外动脉斑块的位置、程度，从而为防治缺血性脑血管病提供更多的临床信息。方法：按照入组标准对入住苏州大学附属第二医院确诊的244例缺血性脑卒中患者，使用双源64层CT机进行扫描，运用多平面重建(MPR)、曲面重建(CPR)、最大密度投影(MIP)和容积显示(VR)技术进行重建，轴位像扩大测量血管直径。通过参照北美症状性颈动脉内膜切除试验（NASCET）标准进行血管狭窄度分级，对检测的结果所得数据进行数理分析。结果：244例缺血性脑卒中患者CTA检查结果示：发现有动脉狭窄的患者194例，其中单纯颅内动脉狭窄的患者50例，单纯颅外动脉的19例，颅内、外动脉均有狭窄的125例，未发现有脑动脉狭窄者50例。即存在颅内动脉狭窄的患者175例，颅外狭窄的患者144例。检测血管3660段，共发现狭窄血管1115处（30.72%，1115/3660），其中颅外血管141处（12.7%，141/1115），颅内血管974处（87.3%，974/1115），其中前循环675处（60.53%，675/1115），后循环440处（39.46%，440/1115）。从狭窄的分布情况看颅内动脉多于颅外动脉，前循环多于后循环，从狭窄程度看颅内、外动脉均以轻中度狭窄为主。发现斑块911处，其中颅外斑块170处（非钙化斑块123处，钙化斑块47处），颅内斑块741处（非钙化斑块137处，钙化斑块604处），颈内动脉颅外段以非钙化斑块为主，颈内动脉颅内段以钙化斑块为主，两者具有明显差异（P<0.001）。结论：国人颅内动脉的狭窄率明显高于颅外动脉，颅内动脉钙化斑块检出率明显多于颅外动脉，颅内动脉狭窄是国人缺血性脑卒中的发病及复发的主要原因。第二部分脑动脉狭窄与高血压关系的研究目的：探讨脑动脉狭窄与高血压的关系，并就脑动脉病变与血压水平关系做进一步分析。方法：按照入组标准选取入住苏州大学附属第二医院的确诊的缺血性脑卒中患者244例。一周内行头颈CTA检查，并记录患者血压、血脂等指标，先对患者CTA结果进行分组，再做颅内、外动脉狭窄与高血压的相关性研究，并进行各组之间血压、血脂等指标的对比研究，最后进行分析综合，得出结论。结果：所有244例缺血性脑卒中患者中，发现有动脉狭窄的患者194例，其中单纯颅内动脉狭窄的患者50例，单纯颅外动脉的19例，颅内、外动脉均有狭窄的125例，未发现有脑动脉狭窄者50例，存在颅内动脉狭窄的患者175例，颅外动脉狭窄的患者144例。颅内动脉、颅外动脉狭窄与高血压相关性研究结果显示：颅内、外动脉狭窄均与高血压呈中度相关，但颅内动脉狭窄与高血压相关性（r=0.667）大于颅外动脉（r=0.503）。无动脉狭窄患者平均年龄、收缩压水平、低于存在脑动脉狭窄的患者，高密度脂蛋白(HDL)水平高于脑动脉狭窄组（p<0.05)，而NHISS评分、甘油三酯、胆固醇、低密度脂蛋白（LDL）、舒张压等与脑动脉狭窄组患者未见有明显差异。按狭窄所在的部位进一步把患者分为4组，可见单纯颅内动脉狭窄组的收缩压水平明显高于无脑动脉狭窄组的患者（p<0.05)，其他各组之间比较未见有明显差异，且存在狭窄程度越重，血压水平越高、降压药物疗效差的趋势。而无脑动脉狭窄组的发病年龄、空腹血糖低于其他组， HDL水平高于其他组（p<0.05)，NHISS评分、甘油三酯、胆固醇、LDL、舒张压等仍未见有明显差异。分别以单纯颅外动脉、颅内动脉是否有狭窄为应变量进行多因素非条件logistic回归分析，在颅外动脉是否有狭窄模型中，高血压的风险比是1.136；在颅内动脉是否有狭窄模型中，高血压的风险比是：1.697，示高血压患者患颅内动脉狭窄风险大于颅外动脉狭窄。结论：高血压与颅内、外动脉狭窄均呈中度相关，与颅内动脉狭窄相关性大于颅外动脉狭窄。存在高血压的患者，患颅内、外动脉狭窄的风险明显高于血压正常者。患颅内动脉狭窄风险大于患颅外动脉狭窄，即高血压是颅内动脉狭窄的重要危险因素。颅内动脉狭窄组的缺血性脑卒中患者，收缩压水平较无动脉狭窄组高，且有颅内动脉狭窄数量越多，狭窄越严重，收缩压水平越高的趋势。更多还原

【Abstract】 Part1Analysis of the cerebral artery CTA results in ischemic stroke patientsObjective: To provide more clinical information for the prevention and treatment ofischemic cerebrovascular disease, the location and extent of the intracranial andextracranial arterial plaque, stenosis (especially intracranial arteries) with CTA in patientswith ischemic stroke were analysed.Methods:244cases of ischemic stroke patients, confirmed in accordance with theinclusion criteria, hospitalized in the Second Affiliated Hospital of Soochow Universitywere enrolled. The cerebral artery were scaned by the dual-source64-slice CT, analysed bythe multi-planar reconstruction (MPR), curved planar reconstruction (CPR), maximumdensityprojection (MIP) and volume rendering (VR) reconstruction technology. The arterydiameter were measured by expanding the axial picture. The classification of vascularstenosis were evaluated according to the North American Symptomatic CarotidEndarterectomy Trial (NASCET) standards. The datas were analysised.Results: The results showed that the artery stenosis occurred in194patients, of which,175cases of patients with intracranial arterial stenosis,50cases with pure intracranialartery stenosis,125cases with intracranial and extracranial arteries.narrow,19cases withextracranial arteries, and50cases without cerebral artery stenosis. A total of3660bloodvessel were evaluated, of which,1115narrow blood vessels (30.72%) and911pieces ofplaques were found. Among the narrow blood vessels,141occurred in the extracranialblood vessels (12.7%),974(87.3%) occurred in the intracranial blood vessels,675(60.53%) occurred in the anterior circulation, and440(39.46%) occurred in the posteriorcirculation. Among the911pieces of plaques,170plaques (123non-calcified plaque,calcified plaque47) occurred in the extracranial segment and741(137non-calcifiedplaque,604calcified plaque) occurred in the intracranial segment. Among the plaques,most non-calcified plaques were found in the extracranial segment of internal carotid artery (P <0.001), most calcified plaque were found in intracranial segment of internal carotidartery (P <0.001).Conclusion: In chinese patients, intracranial arterial stenosis is the main reason forthe incidence and recurrence of ischemic stroke. Compared with the extracranial arteries,there were a higher rate of arterial stenosis and more artery calcified plaques in theintracranial artery. part2Correlation of the cerebral artery stenosis and hypertensionObjective: Study the relationship between cerebral artery stenosis and hypertensionand make a further analysis of correlation of cerebral artery stenosis and blood pressurelevel.Methods:244cases of ischemic stroke patients, confirmed in accordance with theinclusion criteria, hospitalized in the Second Affiliated Hospital of Soochow Universitywere enrolled. All patients were underwent a cerebral artery CTA within week, and theirblood pressure, blood lipids and other indicators were recorded. The patients were devidedinto two groups according to their CTA results, and then analyzed the correlation of thecerebral artery stenosis and hypertension, and compared the blood pressure, lipids andother indicators among the groups. The datas were analysised.Results: The results of correlation of artery stenosis and hypertension showed that notonly the intracranial arteries, but the extracranial artery stenosis, has a moderate correlationwith hypertension. Compared with the extracranial artery stenosis (r=0.503),theintracranial arterial stenosis has a closer correlation with hypertension (r=0.667).According the CTA results,the244cases were divided into two groups:thenone-cerebral artery stenonsis group and cerebral stenosis group. The results showed thatthe average age, systolic blood pressure levels in none-cerebral artery stenonsis group arelower than that of the cerebral artery stenosis group (p <0.05), the level of HDL in serum innone-cerebral artery stenonsis group is higher than that of the cerebral stenosis group.TheNHISS score, glycerol,cholesterol and LDL level, diastolic blood pressure of the twogroup have no significant difference. Based on the cerebral artery stenosis site of CTAresults,the patients were further divided into four groups: the pure intracranial artery stenosis group, pure extracranial artery stenosis group, none artery stenosis group,intracranial and the extracranial artery stenosis group. The results showed that the level ofsystolic blood pressure of pure intracranial artery stenosis group was significantly higherthan that of the none-cerebral artery stenosis group (p <0.05). The level of the bloodpressure has a positive relationship with the degree of arterious stenosis. the higher bloodpressure in the patients of artery stenosis were more difficult to be controlled than noneartery stenosis group by antihypertensive drugs. Conpared to other groups,thenone-cerebral artery stenosis patients have a younger age at onset and a lower level ofblood glucose and a higher serum HDL level,but NHISS score, triglycerides, cholesterol,LDL and diastolic blood pressure have no significant difference among groups. Usingextracranial arterial and intracranial arterial stenosis respectively as dependent variables inmultivariate unconditional logistic regression analysis showed that the risk of hypertensionwas1.136in the extracranial artery stenosis model and1.697in the intracranial arterialstenosis model, suggesting that the high blood pressure patients are more easier to sufferintracranial arterial stenosis than extracranial artery stenosis.Conclusion: The hypertension patient has a closely relationship with cerebral arterystenosis in ischemic stroke patients.The hypertension patients are more easier to sufferintracranial arterial stenosis than extracranial artery stenosis.更多还原