症状性椎动脉狭窄与脑干和小脑梗死关系研究  

Relationship between symptomatic vertebral artery stenosis with brainstem/cerebellar infarction

作　　者：熊静[1] 张婕[1] 韩剑虹[1] 李佳敏[1] 李馨蕊[1] 田红[1] 朱榆红[1] 

机构地区：[1]昆明医科大学第二附属医院神经内科,云南昆明650101

出　　处：《中国医药导报》2014年第28期75-78,共4页China Medical Herald

基　　金：云南省科技惠民计划项目(编号2013CA008)

摘　　要：目的探讨狭窄≥50%的椎动脉狭窄与脑干和小脑梗死的关系。方法回顾性收集经256层螺旋CT血管成像证实有≥50%的症状性椎动脉狭窄54例,引起脑干或小脑梗死。分析症状性椎动脉狭窄的不同部位特点与脑干和小脑梗死的关系。结果椎动脉狭窄引起脑干梗死,腔隙性梗死明显多于区域性梗死(χ2=7.84,P<0.05),引起小脑梗死,区域性梗死明显多于腔隙性梗死(χ2=10.71,P<0.01)。动脉粥样硬化斑块见于45.45%脑干梗死的患者和71.43%小脑梗死患者。椎动脉发育不良见于18.19%脑干梗死的患者和14.29%小脑梗死患者。脑干梗死组中椎动脉颅内段(V4段)狭窄占42.37%,明显高于小脑梗死组(22.44%,χ2=6.25,P<0.05)。小脑梗死组中,椎动脉颅外段(V1段)狭窄占36.73%,明显高于脑干梗死组(20.33%,χ2=5.07,P<0.05)。脑干梗死组合并基底动脉狭窄率为12.12%,明显高于小脑梗死组(4.26%,χ2=4.00,P<0.05)。结论引起脑干和小脑梗死的症状性椎动脉颅内、外段狭窄部位有差异,对脑干和小脑梗死患者尽快进行有效的血管评价,对于选择药物治疗和血管内治疗有重要意义。Objective To investigate the correlation between ≥50% apparently symptomatic vertebral stenosis and the brainsteIn/cerebellar infarction. Methods 54 patients with ≥50% apparently symptomatic vertebral stenosis detected by 256-multislice CT angiography （CTA） were admitted retrospectively. Vertebral stenosis resulted in brainstem/cerebellar infarction. The symptomatic vertebral artery stenosis characteristics in brainstem/cerebellar infarction were analyzed. Results Lacunar infarction in brainstem infarction group due to vertebral artery stenosis was significantly more than territorial infarction （X^2=7.84, P 〈0.05）. Territorial infarction in cerebellar infarction group was significantly more than lacunar infarction （x^2=-10.71, P 〈0.01）. Atherosclerotic plaques were found in 45.45%/71.43% of the cases with brainstem/ cerebellar infarction respectively. Vertebral artery hypoplasia was found in 18.19%/14.29% of the cases with brainstem/ cerebellar infarction respectively. The intracranial vertebral artery （V4 segment） stenosis was significantly higher in the brainstem infarction group （42.37%） than that in the cerebellar infarction group （22.44%, X^2=6.25, P 〈0.05）. The proximal vertebral artery （V1 segment） stenosis was significantly higher in the cerebellar infarction group （36.73%） than that in the brainstem infarction group （20.33%, X^2=5.07, P 〈0.05）. The prevalence of basilar artery stenosis complicated with vertebral artery stenosis was significantly higher in the brainstem infarction group （12.12%） than that in the cerebellar infarction group （4.26%, X^2=4.00, P 〈0.05）. Conclusion The differences of symptomatic extra/intracranial vertebral artery in brainstem/cerebellar infarction indicate that patients with brainstem/cerebellar infarction should be evaluated by image technologies effectively as soon as possible, which will provide the reliable basis of drug treatment and endovascular treatment.

关 键 词：缺血性卒中 脑干病变 小脑病变 CT血管造影 

分 类 号：R743[医药卫生—神经病学与精神病学]