中青年单侧大脑中动脉起始段慢性闭塞后侧支循环与脑梗死的关系  

Relationship between collateral circulation and cerebral infarction after chronic occlusion of the M1 segment of unilateral middle cerebral artery in the young and middle-aged adults

作　　者：刘勇[1] 韩军良[1] 何君宏[1] 刘增艳[1] 赵钢[1] 

机构地区：[1]解放军第四军医大学西京医院神经内科,西安710062

出　　处：《中国脑血管病杂志》2014年第2期84-88,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：陕西省社发攻关基金(省2012K15-02-06)

摘　　要：目的 探讨中青年单侧大脑中动脉起始段（M1段）慢性闭塞后新发脑梗死患者的危险因素和侧支循环建立与脑梗死的关系.方法 回顾性分析2009年7月-2013年6月就诊于解放军第四军医大学西京医院神经内科的90例单纯M1段慢性闭塞患者的临床资料,其中男48例,女42例,平均（44.6±9.7）岁,有新发脑梗死灶者50例,无脑梗死灶者40例.并对新发脑梗死与危险因素和侧支循环（采用ASITN/SIR血流分级评估）建立的情况进行分析.结果 （1）90例M1段慢性闭塞患者年龄分布趋势为50～59岁组最多,占37.8%;20～29岁组最少,占8.9%.有无脑梗死两组患者年龄分布差异无统计学意义（χ2=4.394,P〈0.2）.高血脂、糖尿病、吸烟、高血压、高同型半胱氨酸血症等危险因素与是否发生脑梗死无显著相关性（P均＞0.05）.（2）新发脑梗死组侧支血流分级1、2级占84%（42/50）,3级占16%（8/50）;而无脑梗死组1、2级仅占10%（4/40）,3、4级占90%（36/40）.侧支血流分级与脑梗死发生呈负相关,差异有统计学意义（γs=-0.76,P〉0.01）.结论 因本研究样本量有限,未显示脑血管病的传统危险因素与脑梗死发生具有相关性.M1段慢性闭塞使得侧支循环有充分时间建立,其侧支循环的血流分级越高,越不容易发生脑梗死.Objective To investigate the relationship between the cerebral vascular risk factors and the establishment of collateral circulation after chronic occlusion of the M1 segment of unilateral middle cerebral artery in the young and middle-aged patients with newly attacked cerebral infarction. Methods The clinical data of 90 patients with simple chronic occlusion of M1 segment treated at the Department of Neurology, Xijing Hospital, the Fourth Military Medical University from July 2009 to June 2013 were analyzed retrospectively. Forty-eight of them were males and 42 were females, their mean age was 44.6 ±9.7 years. There were 50 patients with new infarcts and 40 without infarcts. New cerebral infarction and cerebral vascular risk factors, and the establishment of collateral circulation were analyzed. Results （1）The age distribution trend was most in the 50 to 59 age group in 90 patients with chronic occlusion of the M1 segment,accounting for 37.8%, and that was least in the 20 to 29 age group, accounting for 8.9%. There was no significant difference in age of the distribution in patients with or without cerebral infarction between the 2 groups （X2 = 4.394,P 〉 0.2 ）. The risk factors, such as high cholesterol, diabetes, smoking, and high homocysteine, were not significantly correlated with whether the occurrence of cerebral infarction（all P 〉0.05）. （2）Collateral open grade 1 and 2 accounted for 84% （42/50） in the new cerebral infarction group,and grade 3 accounted for 16% （8/50） while grade 1 and 2 only accounted for 10%（4/40） in the non-cerebral infarction group,and grade 3 and 4 accounted for 90% （36/40）. They were higher than those with cerebral infarction. Collateral grade was negatively correlated with the occurrence of cerebral infarction （ T, = - 0.76,P 〈 0.01 ）. Conclusion Due to the limited sample size of this study,it did not show that the traditional risk factors for cerebrovascular disease are correlated with the occurrence of cerebral infarction. Chronic occlusio

关 键 词：梗死 大脑中动脉 小血管阻塞 侧支循环 

分 类 号：R743.3[医药卫生—神经病学与精神病学]