烟雾病合并甲状腺功能亢进症患者的临床分析  

Clinical analysis of patients with moyamoya disease complicating hyperthyroidism

作　　者：李德生[1,2] 刘鹏 暴向阳[1,2] 杨伟中[1,2] 张正善[1,2] 咸鹏[1,2] 杨日淼[1,2] 段炼[1,2] 

机构地区：[1]军事医学科学院附属医院 [2]解放军第三○七医院神经外科,北京100071

出　　处：《中国脑血管病杂志》2011年第12期632-636,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(81171083);首都医学发展科研基金重点项目(2007-2028)

摘　　要：目的探讨烟雾病合并甲状腺功能亢进症(简称甲亢)的临床特征、发病机制、手术及药物治疗的效果。方法回顾性分析11例烟雾病合并亢患者的临床资料,其中经DSA确诊烟雾病10例,MRA确诊1例;所有患者均符合甲亢的诊断标准。8例患者在甲亢稳定后,行脑硬膜颞浅动脉血管融通术,另外3例单纯给予药物控制甲亢。结果①11例患者中8,例为女性,10例有甲状腺功能异常,另一例在入院前,甲亢已被控制。基本上都表现为三碘甲状腺原氨酸(T3)、甲状腺素(T4)增高和促甲状腺激素(TSH)降低。②11例患者中9,例影像学表现为脑梗死,1例表现为脑室内出血,有1例的检查未发现异常(9.1%,1/11)。10例为双侧病变1,例为单侧病变。③对11例患者的随访时间为11～102个月,除1例遗留智力下降、反应慢等症状外,其余患者经治疗后,症状均减轻或消失。8例接受手术治疗的患者术后未出现手术并发症,对其中6例患者术后(10～26个月)进行了造影复查,均显示颅外已向颅内大量代偿供血。结论烟雾病合并甲亢以女性患者为多,临床症状主要表现为脑梗死。二者合并发病机制不明,可能与遗传及免疫等多种因素有关。控制甲亢症状后,行手术治疗能够建立有效的侧支循环。Objective To investigate the clinical features, pathogenesis and the effect of surgical and medical treatment of patients with moyamoya disease complicating hyperthyroidism. Methods The clinical data of 11 patients with moyamoya disease complicating hyperthyroidism were analyzed retrospectively, 10 of them were diagnosed by digital substraction angiography （DSA） , and 1 was diagnosed by magnetic resonance angiography. All the patients met the diagnostic criteria of hyperthyroidism. After controlling hyperthyroidism, 8 patients underwent encephalo-duro-arterio-synangiosis, the other 3 were only given drugs to control hyperthyroidism. Results ①Ten of the 11 patients （ 8 females ） showed thyroid dysfunction, with increased 3,5,3＇-triiodothyronine （T3） and thyroxine （T4） , and the decreased thyroid stimulating hormone （TSH）. ②Nine of the 11 patients showed cerebral infarction, 1 showed intraventricular hemorrhage and 1 did not found any abnormality in imaging findings. Ten patients had bilateral lesions and 1 had unilateral lesions.③ Eleven patients were followed-up for 11-102 months. Except 1 patient left mental decline and slow reaction, the symptoms of others were relieved or disappeared after the treatment. After encephalo-duro-arterio-synangiosis, 8 patients did not have any surgical complications, 6 of them conducted postoperative angiography （10-26 months） and all showed a great deal of compensatory blood supply from extracranial to intracranial arteries. Conclusion Moyamoya disease complicating hyperthyroidism is mostly occured in female patients and their clinical symptoms are mainly cerebral infarction. The pathogenesis of moyamoya disease complicating hyperthyroidism remains unclear. It may be associated with a variety of genetic and immune factors. After controlling hyperthyroidism, surgical treatment can establish effective collateral circulation and reduce the risk of recurrence of stroke.

关 键 词：脑底异常血管网病 甲状腺功能亢进症 脑梗死 烟雾病综合征 

分 类 号：R743.3[医药卫生—神经病学与精神病学]