自发性颈动脉夹层临床特征及不同治疗方法疗效分析  

Clinical characteristics and efficacy analysis of various treatments for spontaneous carotid artery dissection

作　　者：周保宁 化召辉[1] 夏磊[1] 曹辉[1] 焦周阳[1] 徐鹏[1] 张帅[1] 张麒[1] 李震[1] Zhou Baoning;Hua Zhaohui;Xia Lei;Cao Hui;Jiao Zhouyang;Xu Peng;Zhang Shuai;Zhang Qi;Li Zhen(Department of Endovascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院腔内血管外科,郑州450052

出　　处：《中华医学杂志》2024年第5期337-343,共7页National Medical Journal of China

基　　金：河南省高等学校重点科研项目(22A320081)

摘　　要：目的探讨自发性颈动脉夹层(SCAD)临床特征以及不同治疗方法的疗效。方法回顾性分析2018年6月至2023年1月郑州大学第一附属医院164例SCAD患者的临床资料,其中男127例,女37例,年龄(49.5±11.1)岁。根据治疗方法分为保守治疗组(n=100)和手术治疗组(n=64)。分别于出院后3、6、12个月及以后每年1次通过门诊或住院对患者进行随访。分析两组患者住院期间及随访期内脑缺血事件发生率、脑出血事件发生率、死亡率等。采用多因素logistic回归分析影响SCAD血管再通的相关因素。结果164例患者中,18例患者为双侧SCAD,共182支颈动脉纳入研究。缺血性脑卒中(85例,51.8%)和短暂性脑缺血发作(31例,18.9%)是SCAD患者主要临床表现。高血压(81例,49.4%)和高脂血症(39例,23.8%)是SCAD患者主要合并症。住院期间保守治疗组100例患者共113支颈动脉接受药物治疗,无新发脑缺血事件及症状性颅内出血事件发生,无死亡事件。手术治疗组64例患者共69支颈动脉接受手术治疗,手术成功率为97.1%(67/69)。手术治疗组的颈动脉狭窄程度≥90%比例为47.8%(33/69),Ⅱ型SCAD比例为60.9%(42/69),出院接受抗血小板治疗比例为92.8%(64/69),均高于保守治疗组的25.7%(29/113)、45.1%(51/113)、73.5%(83/113)(均P<0.05)。保守治疗组随访时间[M(Q_(1),Q_(3))]为24(13,34)个月,脑缺血事件发生率为8%(9/113),再入院治疗率为7.1%(8/113);手术治疗组随访时间为24(11,38)个月,未出现新发脑缺血事件及死亡事件。多因素logistic回归分析显示,真腔狭窄程度<90%(OR=2.738,95%CI:1.067~7.026,P=0.036)、Ⅰ型夹层(OR=2.656,95%CI:1.189~5.935,P=0.017)是血管完全再通的相关因素。结论缺血性脑卒中和短暂性脑缺血发作是SCAD患者主要临床表现。药物抗栓治疗仍是首选方法,在保守治疗失败后行腔内手术治疗可降低患者远期脑缺血事件再发的风险及再就诊率。Objective To investigate the clinical features of spontaneous carotid artery dissection(SCAD)and the efficacy of different treatment methods.Methods The clinical data of 164 patients with SCAD who were treated at the First Affiliated Hospital of Zhengzhou University from June 2018 to January 2023 were retrospectively analyzed.There were 127 males and 37 females,with a mean age of(49.5±11.1)years.They were divided into conservative treatment group(n=100)and surgical treatment group(n=64)according to whether they received surgical treatment.Patients were followed at 3,6,and 12 months after discharge and annually thereafter through outpatient or inpatient visits.The incidence of cerebral ischemic events,cerebral hemorrhage events,and mortality rates during hospitalization and follow-up periods were analyzed in the two patient groups.To examine correlates of revascularization in SCAD,multifactorial logistic regression analysis was used.Results Of the 164 patients,18 patients had bilateral SCAD and a total of 182 carotid arteries were included in the study.Ischemic stroke(85 cases,51.8%)and transient ischemic attack(31 cases,18.9%)were the main clinical manifestations in SCAD patients.Hypertension(81 cases,49.4%)and hyperlipidemia(39 cases,23.8%)were the main comorbidities in SCAD patients.During hospitalization,100 patients in the conservative treatment group received medication in 113 carotid arteries,no new cerebral ischemic events or symptomatic intracranial hemorrhage events occurred,and no death occurred.A total of 69 carotid arteries were surgically treated in 64 patients in the surgical treatment group.The success rate was 97.1%(67/69).In the surgical treatment group,the proportion of carotid stenosis degree≥90%was 47.8%(33/69),the proportion of typeⅡSCAD was 60.9%(42/69),and the proportion discharged from the hospital to receive antiplatelet therapy was 92.8%(64/69),which were higher than those in the conservative treatment group,which were 25.7%(29/113),45.1%(51/113),and 73.5%(83/113),respectively(all P

关 键 词：颈动脉 动脉瘤 夹层 脑卒中 保守治疗 腔内治疗 

分 类 号：R651.1[医药卫生—外科学]