缺血性卒中患者椎基底动脉扩张延长症的临床和影像学特征：回顾性病例系列研究  

Clinical and imaging features of vertebrobasilar dolichoectasia in patients with ischemic stroke： a retrospective case series study

作　　者：张丽[1] 万慧[2] 韩国哲 郭秀凤[1] 夏英凯[1] 

机构地区：[1]莱芜市莱钢医院神经内科,莱芜271100 [2]南昌大学第一附属医院神经内科,330006 [3]莱芜市莱钢医院麻醉科,莱芜271100

出　　处：《国际脑血管病杂志》2012年第9期672-677,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的比较缺血性卒中患者椎基底动脉扩张延长症（vertebrobasilardolichoectasia，VBD）的临床和影像学特征，探讨缺血性卒中患者VBD以及伴有VBD患者后循环梗死的危险因素。方法急性缺血性卒中患者根据磁共振血管造影（magneticresonanceangioffaphy，MRA）结果分为VBD组和非VBD组，根据牛津郡社区卒中项目分型标准分为前循环梗死和后循环梗死。回顾性收集人口统计学、血管危险因素、影像学和其他临床资料并进行比较，采用多变量logistic回归分析确定VBD以及VBD患者后循环梗死的独立危险因素。结果共纳入269例急性脑梗死患者，28例（10．41％）存在VBD。VBD组年龄[（70．38±10．58）岁对（62．86±12．20）岁；t=2．870，P=0．009]、男性（78．6％对66．8％；χ^2=4．392，P=0．036）和高血压患者比例（89．3％对47．7％；χ^2=17．367，P=0．000）显著高于非VBD组；两组脑梗死亚型也存在显著差异（χ^2=10．776，P=0．015），VBD组以后循环梗死多见（57．1％），非VBD以部分前循环梗死多见（43．6％）。多变量logistic回归分析显示，高龄[优势比（oddsratio，OR）1．248，95％可信区问（confidenceinterval，CI）1．137～1．371；P=0．000]、高血糖（OR1．599，95％CI1．181～2．164；P=0．002）、高血压（OR1．251，95％CI 1．020～1．534，P=0．032）和三酰甘油水平增高（OR1．876，95％CI 1．021～3．445，P=0．043）是VBD的独立危险因素，而女性（OR0．133，95％CI 0．024～0．735；P=0．021）为VBD的独立保护因素。在28例伴有VBD的脑梗死患者中，前循环梗死9例，后循环梗死19例。前循环梗死组基底动脉直径[（5．40±0．49）cm对（6．00±0．77）cm；t=2．046，P=0．041]显著小于后循环梗死组，而基底动脉分叉高度评分（χ^2=6．768，P=0．037）和基底动脉侧移（χ^2=5．241，P=0．042）评分较高者的构成比显著低于后循环梗死�Objective To investigate the clinical and imaging features in patients with vertebrobasilar dolichoectasia （VBD） through a comparative study in patients with ischemic stroke with or without VBD. Methods The patients with acute cerebral infarction were divided into either a VBD group or a non-VBD group according to magnetic resonance angiography. The VBD group was further divided into an anterior circulation infarction subgroup and a posterior circulation infarction subgroup. The cardiovascular risk factors, the diameterof basilar artery （BA）, bifurcation height, and horizontal displacement were compared in all groups. Results A total of 269 patients with acute cerebral infarction were included, 28 had VBD, accounting for 10. 41% of the patients with acute cerebral infarction during the same period. The proportion of male patients （78.6% vs. 66. 8% ;χ^2 =4. 392, P =0. 036）, age （70. 38 ± 10. 58 years vs. 62. 86 ± 12. 20 years; t = 2. 870, P = 0. 009）, and the proportion of hypertension （89. 3% vs. 47. 7% ;χ^2 = 17. 367, P = 0. 000） in the VBD group were significantly higher than those in the non-VBD group. The multivariate logistic regression analysis showed that the advanced age （odds ratio [OR] 1.248, 95% confidence interval [CI] 1. 137- 1.371; P= 0.000）, hyperglycemia （OR 1. 599, 95% CI 1. 181 - 2. 164; P = 0. 002）, hypertension （OR 1. 251, 95% CI 1. 020 - 1. 534; P=0. 032） and increased triglyceride level （OR 1. 876, 95% CI 1.021 - 3. 445; P =0. 043） were the independent risk factors for VBD, while female gender （OR 0. 133, 95% CI 0. 024 -0. 735; P =0. 021） was the independent protective factor for VBD. Of the 28 cerebral infarction patients with VBD, 9 had anterior circulation infarction and 19 had posterior circulation infarction. There were significant differences in BA diameter （[5.40 ± 0. 49 ] em vs. [ 6. 00 ± 0. 77 ] cm; t = 2. 046, P - 0. 041 ）, and the proportions of high score in bifurcation height χ^2 =6. 768, P =0. 037） and horizontal displacement

关 键 词：卒中 脑缺血 基底动脉 椎动脉 磁共振血管造影 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]