不同症状的缺血型烟雾病患者的临床特点  

Clinical Characteristics of Patients with Ischemic Moyamoya Disease with Different Symptoms

作　　者：王成名 刘恒方[1] 张敏[1] 崔明[1] 田建荣 张玉东 王银萍 张婕 王欣格 WANG Chengming;LIU Hengfang;ZHANG Min;CUI Ming;TIAN Jianrong;ZHANG Yudong;WANG Yinping;ZHANG Jie;WANG Xinge(Department of Neouology,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第五附属医院神经内三科,河南郑州450000

出　　处：《河南医学研究》2021年第12期2122-2126,共5页Henan Medical Research

基　　金：河南省医学科技公关计划省部共建项目(SB201901056)。

摘　　要：目的探讨缺血型烟雾病(MMD)患者不同临床症状的特点和影响因素。方法回顾性收集2018年6月至2019年8月于郑州大学第五附属医院就诊的MMD患者的一般临床资料。根据患者的临床症状分为头晕组、短暂性脑缺血发作(TIA)组和脑梗死组。根据患者的数字减影血管造影(DSA)结果行Suzuki分期和侧支循环分类,把侧支循环分为硬脑膜血管吻合系统、软脑膜血管吻合系统、室管膜下血管吻合系统和丘脑、纹状体内血管吻合系统。根据患者MRI中缺血灶的部位分为皮质区、分水岭区、和深穿支区。对患者一般临床资料和侧支循环进行分析。结果TIA组和脑梗死组收缩压水平高于头晕组(P<0.05),头晕组较TIA组和脑梗死组Suzuki分期更晚(P<0.05);脑梗死组皮质区缺血灶发生率高于头晕组和TIA组(P<0.05),TIA组分水岭区缺血灶发生率高于头晕组(P<0.05),TIA组深穿支区域缺血灶发生率高于头晕组和脑梗死组(P<0.05)。脑梗死组软脑膜血管吻合系统发生率高于头晕组和TIA组(P<0.05),头晕组硬脑膜血管吻合系统发生率高于TIA组和脑梗死组(P<0.05),3组间室管膜下血管吻合系统和丘脑纹状体血管吻合发生率差异无统计学意义(P>0.05)。结论缺血型MMD患者不同临床症状的发生与多种因素有关,侧支循环与缺血型MMD患者的临床症状有相关性。软脑膜血管吻合系统与脑梗死的发生有关,硬脑膜血管吻合系统与头晕的发生有关;MMD患者脑缺血患者梗死部位多位于皮质区,TIA缺血灶多发生在分水岭区和深穿支动脉分布区;收缩压水平升高可能与脑梗死和TIA发生有关。Objective To explore the characteristics and influencing factors of different clinical symptoms in patients with ischemic moyamoya disease(MMD).Methods Clinical data of MMD patients with the Fifth Affiliated Hospital of Zhengzhou University from June 2018 to August 2019 were retrospective collected.According to the clinical symptoms,patients were divided into 3 groups:dizziness group,transient ischemic attack(TIA)group and cerebral infarction group.Suzuki staging and collateral circulation classification were performed according to the patients of digital subtraction angiography(DSA)results,and collateral circulation was classified into dura meningeal vascular anastomosis system,pial meningeal vascular anastomosis system,subependymal vascular anastomosis system and vascular anastomosis system in thalamus and striatum.According to the location of the ischemic focus in the patients with MRI,patients were divided into cortical area,watershed area,and deep perforators area.The general clinical data and collateral circulation of the patients were analysed.Results The systolic blood pressure level in the TIA group and the cerebral infarction group were higher than that in the dizziness group(P<0.05).Suzuki staging of dizziness group was later than the TIA group and the cerebral infarction group(P<0.05).The incidence of ischemic foci in the cortical area of cerebral infarction group was higher than that in dizziness group and TIA group(P<0.05),and the incidence of ischemic foci in the watershed area of the TIA group was higher than that in dizziness group(P<0.05),and the incidence of ischemic foci in the deep perforators area of TIA group was higher than that in dizziness group and cerebral infarction group(P<0.05).The incidence of pial meningeal vascular anastomosis system in cerebral infarction group was higher than that in dizziness group and TIA group(P<0.05),and the incidence of the dura meningeal vascular anastomosis system in dizziness group was higher than that in TIA group and cerebral infarction group(P<0.05).

关 键 词：烟雾病 脑血管造影术 侧支循环 

分 类 号：R743[医药卫生—神经病学与精神病学]