Objective Based on MR high resolution vessel wall imaging technique, the risk factors of prognosis in patients with symptomatic intracranial vascular stenosis were investigated. Methods Thirty four patients who diagnosed stroke with symptomatic intracranial vascular stenosis at the Department of Neurology in our hospital during January 2016 to March 2017 were retrospectively selected. The imaging features of intracranial plaques were analyzed with MR high resolution vessel wall imaging. Based on the modified Rankin scale (mRS) 3 months after discharge, the patients were divided into good prognosis and poor prognosis groups. The clinical data, plaque stability and plaque composition of the 2 groups were compared by t test or Fisher exact probability test. The independent risk factors of the poor prognosis were analyzed by Logistic regression. Results There were significant differences in the history of diabetes, the history of hypertension, lumen stenosis rate>50%, and the stability of plaques between the 2 groups (P<0.05). The percentage of poor prognosis in the unstable plaque group was higher than that of plaque stable group (78% vs. 22%); the percentage of good prognosis in unstable plaque group was lower than the plaque stable group (36%vs. 64%). There was significant difference in plaque stability between the 2 groups (P=0.031). The proportion of intraplaque hemorrhage and necrosis of the lipid core was significantly higher in the poor prognosis group than the good prognosis group (P<0.05);the presence of calcification plaque and lumen stenosis rate>50%did not significantly differ between poor and good prognosis groups (P>0.05). The history of hypertension, history of diabetes, degree of intracranial stenosis, and the stability of plaques were the independent risk factors for the poor prognosis of stroke. Conclusion High resolution MR vessel wall imaging technique is of great value in evaluating the prognosis of stroke patients with symptomatic intracranial vascular stenosis. Hypertension, diabetes mellitus, intracranial arterial stenosis, and plaque stability might be independent risk factors for the poor prognosis of stroke. Among that, the degree of intracranial arterial stenosis and the stability of plaque are the two most important factors.%目的 基于高分辨MR血管壁成像技术探究症状性颅内血管狭窄的脑卒中病人预后的危险因素.方法 本研究回顾性分析2016年1月—2017年3月就诊于我院神经内科的34例症状性颅内血管狭窄的脑卒中病人资料,利用高分辨MR血管壁成像技术,分析病人颅内斑块的影像特点,并于出院3个月后对病人进行改良Rankin量表(mRS)评分,据此将病人分为预后好组与预后差组.采用t检验或Fisher确切概率检验对2组病人的临床资料及斑块稳定性、斑块成分进行比较,通过Logistic回归分析脑卒中病人预后差的独立危险因素.结果 2组病人的糖尿病病史、高血压病史、管腔狭窄率>50%及斑块的稳定性差异均有统计学意义(均P<0.05).预后差组中不稳定性斑块占比(78%)高于稳定性斑块的(22%),预后好组中不稳定性斑块占比(36%)低于稳定性斑块的(64%),2组斑块稳定性差异有统计学意义(P=0.031).预后差组中斑块内出血和脂质坏死核心所占比例高于预后好组,2组间差异均有统计学意义(均P<0.05);预后差组与预后好组斑块内钙化及管腔狭窄率>50%所占比例差异均无统计学意义(均P>0.05).高血压病病史、糖尿病病史、颅内动脉狭窄度、斑块的稳定性是脑卒中预后差的独立危险因素.结论高分辨MR血管壁成像技术对症状性颅内血管狭窄的脑卒中病人预后具有很好的评估价值.影响预后的独立因素包括高血压病病史、糖尿病病史、颅内动脉狭窄程度及斑块的稳定性,其中斑块是否稳定及颅内动脉狭窄程度是最关键的两个因素.
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