椎基底动脉迂曲扩张症的相关影响因素及其血流动力学变化的临床研究  

Influencing factors of vertebrobasilar dolichoectasia and hemodynamics changes in these patients

作　　者：王国卿[1] 封丽芳[1] 孙明东[1] 刘龙龙[1] 沈像鹏[1] 张晓[1] 王忠功[1] 陈春富[2] 

机构地区：[1]滨州市人民医院神经内科,256600 [2]山东大学附属省立医院神经内科,济南250021

出　　处：《中华神经医学杂志》2012年第8期827-831,共5页Chinese Journal of Neuromedicine

基　　金：山东省医药卫生科技发展计划项目（2009第HW002）

摘　　要：目的探讨椎基底动脉迂曲扩张症（VBD）的相关影响因素及其血流动力学的变化特点。方法对滨州市人民医院神经内科自2008年6月至2009年9月门诊或住院的后循环脑缺血患者行颅脑MRA检查，以符合VBD标准的116例患者为VBD组，剩余的无VBD的130例患者为对照组。应用单因素分析、多因素分析方法研究高血压、吸烟、糖尿病、低密度脂蛋白（LDL）及其他颅内血管变异等与VBD的关系。探究影响VBD的因素。应用经颅多普勒（TCD）超声、全脑血管造影（DSA）观察VBD患者的血液动力学变化、动脉硬化程度等。结果（1）单因素分析显示：VBD组在有无其他颅内血管变异、高血压、吸烟方面与对照组比较差异有统计学意义（X^2=-13．530，P=-0．000;X^2=8．539，P=-0．003；产3．959，P=-0．047），在与糖尿病、高LDL方面与对照组比较差异无统计学意义（X^2=0．451，P=-0．519;X^2=0．220，P=0．881）。多因素分析显示：VBD与有无其他颅内血管变异（OR=21．732，95％CI：3．02～5．94）、高血压（OR=5．173，95％CI：1．23-3．05）及吸烟（OR=3．145，95％CI：1．86-4．85）呈明显相关性。f2）TCD检测发现，VBD组患者收缩期峰值血流速度、平均血流速度明显低于对照组，而血管搏动指数及阻力指数明显高于对照组，差异均有统计学意义（P〈0．05）。DSA检查提示相同时间内VBD组血液流过的长度较对照组明显减短，差异有统计学意义（P〈0．05）。结论VBD的发生与血管变异、吸烟及高血压相关，并出现血流速度减慢、血管硬化加重，这可能为其导致卒中高发的原因。Objective To study the related influencing factors involving in vertebrobasilar dolichoectasia （VBD） and changing characteristics of hemodynamics of VBD. Methods Outpatients and inpatients with posterior circulation ischemia （PCI） underwent brain MRA from June 2008 to September 2009 were chosen; 116 patients met the standard of VBD were selected as VBD group and other 130 patients without VBD were as control group. The univariate analysis and multiple factor analysis were applied to study the correlation of hypertension, smoking, diabetes, low-density lipoprotein （LDL） and intracranial vascular variation with VBD. Transcranial Doppler （TCD） ultrasound and digital subtraction angiography （DSA） were applied to observe the hemodynamic changes and arteriosclerosis of these patients. Results Univariate analysis indicated that statistical significance on intracranial vascular variation, hypertension and smoking was noted between the VBD group and the control group （X^2=-13.530, P=-0.000; X^2=8.539, P=0.003; ,X^2=3.959, P=-0.047）, while no statistical significance in diabetes and LDL was obtained between the 2 groups （X^2=0.451, P=-0.519; X^2=0.220, P=-0.881）. Multiple factors analysis showed that VBD could be obviously related to intracranial vascular variation （OR=21.732, 95%CI：3.02-5.94）, hypertension （OR=5.173, 95%CI： 1.23-3.05） and smoking （OR=3.145, 95%CI： 1.86-4.85）. According to TCD, peak velocity （Vp）, mean velocity （Vm） in the VBD group were significantly lower than those in the control group, but pulsatility index （PI） and resistant index （RI） in the VBD group were statistically higher （P〈0.05）. DSA showed that the blood flow length of the VBD group was obviously shorter than that of the control group in the same time with statistical significance （P〈0.05）. Conclusion Vascular variation, smoking and hypertension are related to VBD; and VBD leads to slow blood flow and aggravated arteriosclerosis, which may result in high incidence of st

关 键 词：椎基底动脉迂曲扩张症 后循环脑缺血 影响因素 血流动力学 

分 类 号：R743.33[医药卫生—神经病学与精神病学]