短暂性脑缺血发作临床表现与病变血管及侧支循环的关系  

Relationship between the clinical manifestations of transient ischemic attack and the responsible vessels and its collateral circulation

作　　者：杜娟[1] 蔡艺灵[1] 吴铮[1] 崔永强[1] 吴樵[1] 王贵平[1] 

机构地区：[1]解放军第三0六医院神经内科,北京100101

出　　处：《中国脑血管病杂志》2013年第8期401-405,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：首都临床特色应用研究基金资助项目(Z13110700220000)

摘　　要：目的探讨短暂性脑缺血发作(TIA)的临床表现与病变血管及侧支循环的关系。方法纳入158例在发病的1～7d内行全脑DSA检查的TIA患者。根据临床表现将其分为前循环TIA组和后循环TIA组。分析两组患者的脑动脉狭窄、侧支循环建立情况及临床表现与责任病变血管的符合情况。结果①158例TIA患者中,临床表现为前循环TIA 32例(20.3%),后循环TIA126例(79.7%)。122例(77.2%)存在颅内外动脉狭窄或闭塞;36例(22.8%)颅内外动脉均正常,全部为后循环TIA组。②32例前循环TIA患者中,28例有颈内动脉系统责任动脉狭窄,符合率为87.5%;126例后循环TIA患者中,66例有椎-基底动脉系统责任动脉狭窄,符合率为52.4%;差异有统计学意义,P<0.01。③以Willis环交通动脉代偿率最高,可达81.0%(128/158),软脑膜代偿率10.1%(16/158),颈外动脉代偿率6.3%(10/158),前、后循环组TIA患者各级侧支代偿方式差异无统计学意义,P>0.05。18例患者的侧支循环代偿途径≥2种,其中4例为前循环TIA,均为症状与DSA符合者;14例为后循环TIA,其中8例为症状与DSA不符合者。结论前循环TIA较后循环TIA者临床症状与责任病变血管的符合率高,且均以Willis环代偿为主。Objective To investigate the relationship between the clinical symptoms of transient ische- mic attack （TIA） and the findings of digital subtraction angiography （DSA） images Methods A total of 158 patients with TIA who performed cerebral digital subtraction angiography （DSA） within 1 to 7 clays after symptom onset were enrolled in the study. The patients were divided into either an anterior circulation TIA group or a posterior circulation TIA group according to the clinical symptoms. Cerebral artery stenoses, estab- lishment of collateral circulation as well as the consistence of clinical symptoms and guilty arteries of the pa- tients in both groups were analyzed. Results Of the 158 patients, the clinical symptoms of 32 were anterior circulation TIA and 126 were posterior circulation TIA. 122 patients （77.2%） had extracranial and intracra- nial artery stenosis or occlusion; the extracranial and intracranial arteries of the 36 patients （22.8%） were normal, and they were all the patients of posterior circulation TIA group. （~）In the 32 patients with anterior circulation TIA, 28 had guity artery stenosis in the internal carotid artery system, and the compliance rate was 87.5%; in the 126 patients with posterior circulation TIA, 66 had guilty artery stenosis in the verte- brobasilar system, and the compliance rate was 52.4%. The difference was statistically significant （ P 〈 0.01 ）. （~The compensatory rate of communicating artery of the circle of Willis was the highest in 158 pa- tients, up to 81.0% （128/158）. The compensatory rate of leptomeningeal collateral circulation was 10.1% （16/158） , and the compensatory rate of the external carotid artery collateral circulation was 6.3% （10/158 ）. There were no significant differences in the modes of all levels of collateral circulation between the an- terior circulation TIA and posterior circulation TIA patients （P 〉0.05 ）. The collateral circulation of 18 pa- tients had 2 or more approaches, 4 of them were anterior circula

关 键 词：脑缺血发作 短暂性 血管造影术 数字减影 症状 侧支循环 

分 类 号：R743.3[医药卫生—神经病学与精神病学]