伴有抗心磷脂抗体阳性脑血管炎的临床和影像学特点  

The MRI Characteristics and Clinical Manifestations of Cerebral Vasculitis Associated with Positive Anticardolipin Antibodies

作　　者：方燕南[1] 张爱武[1] 李花 江晓军[1] 朱剑平[1] 余辉云[1] 

机构地区：[1]中山大学附属第一医院神经内科,广东广州510080 [2]广东三九脑科医院神经内科,广东广州510510

出　　处：《中国神经免疫学和神经病学杂志》2007年第2期97-101,共5页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家自然科学基金资助项目(30572459)

摘　　要：目的总结伴有抗心磷脂抗体(aCL)阳性脑血管炎的临床和影像学特点,并提出其临床影像学诊断要点。方法回顾性分析1995-08-2005-05收集的36例抗心磷脂抗体(anticardiolipin antibodies,aCL)阳性、拟诊脑血管炎患者的临床资料,结合文献复习进行讨论。结果36例患者中男性(69.4%)多于女性(30.6%),以20～32岁为主(80.6%),临床表现以头痛(50.0%)、头晕(50.0%)、偏瘫(72.2%)居多。所有病例均行MRI和MRA检查,MRI特异性改变脑梗死病灶位于皮层、白质和深部灰质,MRA结果显示受累血管为颅内大中型动脉的分支。治疗期间复查MRI可见病灶新旧交替,但病灶基本对称分布且为多发,病灶周围或靠近脑膜处有少量渗血,患者中41.7%(15/36)的MRA结果提示有大脑前中后动脉分支变稀疏,血管边缘毛糙不清,呈串珠样改变。5例行DWI检查者可见细胞性脑水肿改变。5例行DSA检查者可见颅内大动脉狭窄闭塞。所有患者均接受糖皮质激素治疗,临床症状缓解。结论联合行MRI、DWI及MRA检查对该病的诊断具有独到的价值;结合临床特点,aCL阳性,排除大动脉炎、特殊病因及吸毒后血管炎患者应考虑伴有抗心磷脂抗体阳性的脑血管炎。Objective To summarize the MRI characteristics and clinical manifestations of cerebral vasculitis with the presence of anticardiolipin antibodies （aCLs）, and to put forward the main points of diagnosis. Methods Thirty six cases with cerebral vasculitis were collected range from 1995-08 to 2005-05. The clinical data of the patients supported by MRI and clinical analysis were analyzed retrospectively, and the literatures were reviewed. Results The patients were 14-48 years old, male vs female ratio was 2.3 ： 1. The most common symptoms included headache （50.0%）, dizziness （50. 0%） and hemiparesis （72. 2%）. That all the cases had a mild course and recovered shortly after glucocorticosteroid therapy seemed to be consistent with the subgroup of benign angiopathy of cerebral vasculitis. MRI and MRA（41.7%）showed multifocal small infarction and smaller cerebral artery branch or artery terminations, and DWI in 5 cases detected smaller infarct lesions and cytotoxic edema in infarct area invisible on conventional MRI. All these findings suggested a vascular disease involving acute infarction. All the five DSA cases confirmed the MRA findings. All the patients received glucocorticosteroid combined with immunoglobulin treatment got significant recovery. Conclusions MRI, DWI combined with MRA valued important for the diagnosis of cerebral vasculitis. The imageologic features of cortical, subcortical and deep white matter lesions, areas of bleed and heterogeneous parenchymal, leptomeningeal enhancement in combination with clinical presentation and the presence of anticardolipin antibodies, and if Takayasu＇s arteritis, drug abuse and other source arteritis were excluded, can suggest a diagnosis of cerebral vasculitis with positive anticardolipin antibodies.

关 键 词：脑血管炎 影像学 抗心磷脂抗体 

分 类 号：R743[医药卫生—神经病学与精神病学]