儿童缺血型烟雾病的临床和影像分析  

Clinical and Imaging Analysis of Ischemic Moyamoya Disease in Children

作　　者：张谦[1] 王嵘[1] 张东[1] 张岩[1] 赵元立[1] 赵继宗[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100050

出　　处：《中国卒中杂志》2013年第4期261-265,共5页Chinese Journal of Stroke

基　　金：国家十一五科技支撑计划项目-脑卒中外科综合治疗技术体系研究(2006BAI01A13)

摘　　要：目的分析儿童缺血型烟雾病患者的临床和影像特点,探讨脑梗死的相关因素。方法回顾性分析2011年6月～2012年6月收治的27例儿童缺血型烟雾病患者的临床及影像学资料。大脑半球分为无脑梗死半球32侧和脑梗死半球22侧,将患者性别、年龄、造影特点(包括54侧半球的Suzuki分期、大脑后动脉分期,眼动脉、颞浅动脉、脑膜动脉、枕动脉、上颌动脉和后循环向前循环代偿)与脑梗死的发生进行统计分析。结果 27例患者的临床资料显示性别和年龄与脑梗死的发生差异不具有显著性(性别χ2=2.095,P=0.148;年龄χ2=4.286,P=0.453)。根据半球计算:皮质脑梗死17侧(17/22),额叶梗死14侧(14/22),皮质下脑梗死9侧(9/22)。无梗死侧半球和梗死侧半球Suzuki分期以及大脑后动脉分期的差异具有显著性(Suzuki分期Z=-3.054,P=0.002;大脑后动脉分期Z=-4.557,P<0.001)。眼动脉、颞浅动脉、脑膜动脉、枕动脉、上颌动脉和后循环向前循环代偿与脑梗死的发生差异不具有显著性。结论本研究显示儿童缺血型烟雾病皮质脑梗死较皮质下脑梗死常见。在皮质脑梗死中,额叶脑梗死最常见。脑梗死的发生与Suzuki分期和大脑后动脉受累程度有关。Objective To analyze the clinical and radiological findings of ischemic moyamoya disease（MMD） in children and the risk factors of cerebral infarction in these patients. Methods The clinical and imaging data of 27 patients（54 cerebral hemispheres） with pediatric and ischemic MMD from June 2011 to June 2012 were analyzed retrospectively. Fifty-four cerebral hemispheres were divided into hemisphere without infarction（32） and with infarction（22）. The relationship between cerebral infarction and patient＇s gender, age, as well as characteristics of angiography（including Suzuki stage, posterior cerebral artery[PCA] stage, collateral circulation from ophthalmic artery or superficial temporal artery or meningeal artery or occipital artery, or internal maxillary artery or extracranial artery or posterior circulation） were analyzed with χ2 test and Mann-Whitney U test. Results Patient＇s gender and age were not associated with the risk of cerebral infarction（χ2=2.095, P=0.148; χ2=4.286, P=0.453）. Among all the cerebral hemispheres, there are 17 cortical infarction（17/22）, 14 frontal lobe infarction（14/22）, and 9 subcortical infarction（9/22）. The disparity between Suzuki stage of hemispheres without infarction and with infarction is of statistical significance（Mann-Whitney U test Z=-3.054, P=0.002）. The similar result was also observed by PCA stage（Mann-Whitney U test Z=-4.557, P〈0.001）. There were no statistically significant differences between cerebral infarction and every collateral circulation from ophthalmic artery or superficial temporal artery or meningeal artery or occipital artery, or internal maxillary artery or posterior circulation. Conclusion Cortical infarction is more common than the subcortical one in children with ischemic MMD. And frontal lobe infarction has the highest prevalence. The occurrence of cerebral infarction is associated with steno-occlusive lesions of advanced Suzuki stage and PCA stage.

关 键 词：烟雾病 儿童 缺血型 脑血管造影 脑梗死 

分 类 号：R743.3[医药卫生—神经病学与精神病学]