壁内血肿型颈动脉夹层血管再通的相关因素分析  

Analysis of factors related to recanalization of intramural hematoma-type carotid artery dissection

作　　者：黄莹 惠品晶[1] 丁亚芳[1] 颜燕红[1] 刘曼[1] 孔丽娟[1] 胡春洪[2] 方琪[3] Huang Ying;Hui Pinjing;Ding Yafang;Yan Yanhong;Liu Man;Kong Lijuan;Hu Chunhong;Fang Qi(Department of Carotid and Cerebralvascular Ultrasonography,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Imaging,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Neurology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院卒中中心-颈脑血管超声科,苏州215006 [2]苏州大学附属第一医院影像科,苏州215006 [3]苏州大学附属第一医院神经内科,苏州215006

出　　处：《中华医学杂志》2020年第33期2612-2617,共6页National Medical Journal of China

基　　金：苏州市民生科技示范工程项目(SS201714,SS201859);江苏省干部保健科研项目(BJ17010);江苏省医学创新团队(领军人才)(CXTDA2017026);科技部十三五重大专项(2017YFC0114302)。

摘　　要：目的探讨壁内血肿型颈动脉夹层(CAD)血管再通的相关因素。方法回顾性分析2015年8月至2019年5月在苏州大学附属第一医院卒中中心由基于颈部血管超声(CDU)的多模式影像学检查证实的壁内血肿型CAD患者56例(61支CAD),收集其临床及影像学资料,发病至就诊时间以14 d为界。于发病后3、6、12个月行CDU随访,根据随访12个月的结果分为完全再通组和不全再通组,比较两组患者临床资料、超声表现及药物治疗情况,采用多因素logistic回归分析观察影响血管再通的相关因素。结果血管再通情况:完全再通组36支,3、6、12个月血管完全再通率分别为42.6%(26/61)、55.7%(34/61)及59.0%(36/61);不全再通组25支:残余狭窄26.2%(16/61)、持续闭塞14.8%(9/61)。完全再通组与不全再通组比较:发病至就诊时间≤14 d的比例、壁内血肿的回声类型、血管闭塞的比例差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,发病至就诊时间≤14 d(OR=5.625,95%CI:1.302~24.293,P=0.021)、低回声壁内血肿(OR=4.888,95%CI:1.304~18.320,P=0.019)与完全再通呈正相关,夹层血管闭塞(OR=0.234,95%CI:0.059~0.932,P=0.039)与完全再通呈负相关。结论CDU显示对于低回声壁内血肿型CAD,急性期药物治疗完全再通率较高,夹层血管闭塞者完全再通率降低,及早评估可为临床个体化治疗提供依据。Objective To investigate the factors related to recanalization of intramural hematoma-type carotid artery dissection(CAD).Methods Retrospective analysis was performed on 56 patients(61 CADs)with intramural-hematoma type CAD confirmed by multimodal imaging examination based on cervical vascular ultrasound(CDU)in the Stroke Center of the First Affiliated Hospital of Suzhou University from August 2015 to May 2019.The clinical and imaging data were collected,and the time from onset to visit is bounded by 14 days.CDU follow-up was performed at 3,6,and 12 months after the onset.According to the results of the 12-month follow-up,patients were divided into complete recanalization group and incomplete recanalization group.The clinical data,ultrasonic manifestations and drug treatment of patients between the two groups were compared.Multivariate logistic regression analysis was used to analyze the related factors affecting vascular recanalization.Results Vascular recanalization:the rates of complete recanalization at 3,6 and 12 months were 42.6%(26/61),55.7%(34/61)and 59.0%(36/61),respectively.While among the 25 vessels in the incomplete recanalization group,26.2%(16/61)showed residual stenosis and 14.8%(9/61)showed persistent occlusion.Comparison between the complete recanalization group and the incomplete recanalization group:the differences in the proportion of time from onset to visit≤14 days,the echo type of intramural hematoma,and the proportion of vascular occlusion were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that the time from onset to visit≤14 days(OR=5.625,95%CI:1.302-24.293,P=0.021),and the hypoechoic intramural hematoma(OR=4.888,95%CI:1.304-18.320,P=0.019)were positively correlated with complete recanalization,while the dissection vascular occlusion(OR=0.234,95%CI:0.059-0.932,P=0.039)was negatively correlated with complete recanalization.Conclusions CDU showed that hypoechoic intramural hematoma-type CAD treated with standard medications in the acute phase had

关 键 词：动脉瘤 夹层 超声检查 随访 再通 

分 类 号：R743[医药卫生—神经病学与精神病学]