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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 164 -169. doi: 10.3877/cma.j.issn.1674-0785.2022.02.010

临床研究

HRMRI评估颈动脉粥样硬化斑块特征与老年脑梗死及其血清Hcy、hs-CRP和MMP-9关系
陆凯1, 马红芳1,†(), 潘昌杰1, 张敏2   
  1. 1. 213164　江苏常州，常州市第二人民医院医学影像科
    2. 213164　江苏常州，常州市第二人民医院神经内科
  • 收稿日期:2021-05-28 出版日期:2022-02-15
  • 通信作者: 马红芳
  • 基金资助:
    常州市科技项目应用基础研究计划(CJ20180071)

Relationship of features of carotid atherosclerosis plaques evaluated by high-resolution magnetic resonance imaging with cerebral infarction and serum Hcy, hs-CRP, and MMP-9 in elderly people

Kai Lu1, Hongfang Ma1,†(), Changjie Pan1, Min Zhang2   

  1. 1. Department of Medical Imaging, Changzhou Second People's Hospital, Changzhou 213164, China
    2. Department of Neurology, Changzhou Second People's Hospital, Changzhou 213164, China
  • Received:2021-05-28 Published:2022-02-15
  • Corresponding author: Hongfang Ma
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陆凯, 马红芳, 潘昌杰, 张敏. HRMRI评估颈动脉粥样硬化斑块特征与老年脑梗死及其血清Hcy、hs-CRP和MMP-9关系[J/OL]. 中华临床医师杂志(电子版), 2022, 16(02): 164-169.

Kai Lu, Hongfang Ma, Changjie Pan, Min Zhang. Relationship of features of carotid atherosclerosis plaques evaluated by high-resolution magnetic resonance imaging with cerebral infarction and serum Hcy, hs-CRP, and MMP-9 in elderly people[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(02): 164-169.

目的

采用高分辨磁共振（HRMRI）评估颈动脉粥样硬化（CAS）斑块与老年脑梗死及其血清同型半胱胺酸（Hcy）、超敏C反应蛋白（hs-CRP）和基质金属蛋白酶9（MMP-9）关系。

方法

选取2017年12月至2019年12月常州市第二人民医院确诊的42例老年急性脑梗死患者为脑梗死组，以同期42例存在CAS斑块的非脑梗死患者为非脑梗死组，另选42例同期健康体检者为对照组。MRI检测脑梗死组和非脑梗死组斑块稳定性，测量斑块厚度（PT）、管腔面积（LA）、血管总面积（TVA）、管壁面积（WA）、管壁标准化指数（NWI）和管腔狭窄程度（LS）。酶联免疫吸附法（ELISA）检测所有对象血清Hcy、MMP-9和hs-CRP水平。ROC分析血清Hcy、MMP-9和hs-CRP对脑梗死的诊断价值，Pearson相关性分析CAS斑块特征与血清Hcy、CRP和MMP-9间的关系。

结果

脑梗死患者不稳定型斑块所占比例为63.38%，明显高于非脑梗死患者的2.94%（P＜0.05）；PT、TVA、WA、NWI、LS明显高于非脑梗死组（P＜0.05），LA明显低于非脑梗死组（P＜0.05）。脑梗死组血清Hcy、CRP和MMP-9水平明显高于非脑梗死组和对照组（P＜0.05），非脑梗死组血清Hcy、CRP和MMP-9水平明显高于对照组（P＜0.05）。血清Hcy、CRP、MMP-9及其联合检测诊断脑梗死的AUC分别为0.780、0.752、0.730和0.859（P＜0.05）。斑块稳定性、PT、WA、NWI、LS均与血清Hcy、CRP和MMP-9水平呈正相关关系（P＜0.05），LA与血清Hcy、CRP和MMP-9水平呈负相关关系（P＜0.05）。

结论

CAS斑块的HRMRI特征与老年脑梗死的发生及其血清Hcy、hs-CRP和MMP-9水平变化具有显著的相关性。

关键词: 高分辨磁共振, 颈动脉粥样硬化, 脑梗死, 斑块
Objective

To evaluate the relationship of the features of carotid atherosclerosis (CAS) plaques evaluated by high-resolution magnetic resonance imaging (HRMRI) with cerebral infarction and serum homocysteine (Hcy), high-sensitivity C-reactive protein (hs-CRP), and matrix metalloproteinase 9 (MMP-9) in elderly people.

Methods

A total of 42 patients who were confirmed with acute cerebral infarction (ACI) at Changzhou Second People's Hospital from December 2017 to December 2019 were enrolled as a cerebral infarction group, 42 non-cerebral infarction patients with CAS plaques during the same period were enrolled as a non-cerebral infarction group, and 42 healthy controls during the same period were enrolled as a control group. The plaque stability in the cerebral infarction group and non-cerebral infarction group was detected by HRMRI. The plaque thickness (PT), lumen area (LA), total vessel area (TVA), wall area (WA), normalized wall index (NWI), and lumen stenosis (LS) were measured. The levels of serum Hcy, MMP-9, and hs-CRP were detected by enzyme-linked immunosorbent assay. The diagnostic value of serum Hcy, MMP-9, and hs-CRP in cerebral infarction was assessed by ROC curve analysis. The relationship between the features of CAS plaques and serum Hcy, CRP, and MMP-9 was analyzed by Pearson correlation analysis.

Results

The proportion of unstable plaques in the cerebral infarction group was significantly higher than that in the non-cerebral infarction group (63.38% vs 2.94%, P＜0.05), PT, TVA, WA, NWI, and LS were significantly higher (P＜0.05), and LA was significantly lower in the cerebral infarction group than in the non-cerebral infarction group (P＜0.05). The levels of serum Hcy, CRP, and MMP-9 were significantly higher in the cerebral infarction group than in the non-cerebral infarction group and control group (P＜0.05), and in the non-cerebral infarction group than in the control group (P＜0.05). The area under the curve values of serum Hcy, CRP, and MMP-9 and their combination for diagnosis of cerebral infarction were 0.780, 0.752, 0.730, and 0.859, respectively (P＜0.05). Plaque stability, PT, WA, NWI, and LS were positively correlated with serum Hcy, CRP, and MMP-9 levels (P＜0.05), while LA was negatively correlated with them (P＜0.05).

Conclusion

HRMRI features of CAS plaques significantly correlate with the occurrence of cerebral infarction in elderly people and the changes in levels of serum Hcy, hs-CRP, and MMP-9.

Key words: High-resolution magnetic resonance imaging, Carotid atherosclerosis, Cerebral infarction, Plaque
图1 脑梗死患者CAS斑块的HRMRI影像学表现。图a为3D-TOF序列图像示右侧额颞叶大面积急性脑梗死Ⅳ-Ⅴ型斑块；图b为T1WI序列图像示右侧额颞叶大面积急性脑梗死Ⅳ-Ⅴ型斑块；图c为T2WI序列图像示右侧额颞叶大面积急性脑梗死Ⅳ-Ⅴ型斑块；图d为3D-TOF序列图像示右侧颈总动脉Ⅰ-Ⅱ型CAS斑块；图e为T1WI序列图像示右侧颈总动脉Ⅰ-Ⅱ型CAS斑块；图f为T2WI序列图像示右侧颈总动脉Ⅰ-Ⅱ型CAS斑块注：白色箭头为斑块；CAS为颈动脉粥样硬化
表1 HRMRI检测脑梗死患者CAS斑块稳定性
组别 斑块数 不稳定型斑块 稳定型斑块
Ⅳ~Ⅴ型 Ⅵ型 Ⅰ~Ⅱ型 Ⅲ型 Ⅶ型 Ⅷ型
脑梗死组 71 24（33.80） 21（29.58） 7（9.86） 10（14.08） 4（5.63） 5（7.04）
非脑梗死组 68 2（2.94） 0（0.00） 57（83.82） 6（8.82） 1（1.47） 2（2.94）
表2 HRMRI检测脑梗死患者CAS斑块负荷（
xˉ
±s）
组别 例数 PT（mm） LA（mm2） TVA（mm2） WA（mm2） NWI LS（%）
脑梗死组 42 2.85±0.64 35.20±8.22 75.71±9.87 40.23±9.05 0.54±0.14 46.82±9.63
非脑梗死组 42 2.56±0.57 40.07±8.54 70.56±10.23 30.82±8.74 0.43±0.10 46.82±9.63
t值 2.193 2.663 2.348 4.847 4.144 3.467
P值 0.031 0.009 0.021 ＜0.001 0.005 ＜0.001
表3 脑梗死患者血清Hcy、CRP和MMP-9水平（
xˉ
±s）
组别 例数 Hcy（μmol/L） CRP（mg/L） MMP-9（μg/L）
脑梗死组 42 21.62±5.81ab 15.82±4.86ab 158.46±30.41ab
非脑梗死组 42 15.49±4.90a 11.83±3.22a 120.50±28.45a
对照组 42 11.21±2.77 6.41±1.72 86.71±12.74
F值 52.682 76.076 85.604
P值 ＜0.001 ＜0.001 ＜0.001
图2 血清Hcy、CRP和MMP-9诊断脑梗死的ROC曲线注：Hcy为同型半胱胺酸；CRP为C反应蛋白；MMP-9为基质金属蛋白酶9
表4 血清Hcy、CRP和MMP-9诊断脑梗死的ROC特征
指标 AUC 95%CI P值
Hcy 0.780 0.698~0.860 ＜0.001
CRP 0.752 0.666~0.838 ＜0.001
MMP-9 0.730 0.641~0.814 ＜0.001
联合诊断 0.859 0.794~0.928 ＜0.001
表5 CAS斑块稳定性和负荷与血清Hcy、CRP和MMP-9水平间的相关性
斑块特征 Hcy CRP MMP-9
r值 P值 r值 P值 r值 P值
斑块稳定性 0.481 ＜0.001 0.462 ＜0.001 0.473 ＜0.001
PT 0.425 ＜0.001 0.406 ＜0.001 0.411 ＜0.001
LA -0.284 0.005 -0.212 0.030 -0.217 0.026
TVA 0.192 0.053 0.116 0.237 0.139 0.162
WA 0.368 ＜0.001 0.335 0.001 0.348 ＜0.001
NWI 0.386 ＜0.001 0.354 ＜0.001 0.390 ＜0.001
LS 0.402 ＜0.001 0.384 ＜0.001 0.393 ＜0.001
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