急性椎-基底动脉系统脑梗死的临床特点研究  

Clinical features of acute vertebrobasilar system cerebral infarction

作　　者：关颖[1] 刘广志 GUAN Ying;LIU Guangzhi(Department of Neurology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所神经内科,100029

出　　处：《心肺血管病杂志》2022年第11期1155-1159,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(82071342)。

摘　　要：目的:通过对比分析急性颈内动脉系统和椎-基底动脉系统脑梗死的临床资料,总结急性椎-基底动脉系统脑梗死的临床特点。方法:回顾性分析2021年2月至2021年7月,首都医科大学附属北京安贞医院收治的324例急性脑梗死的一般情况、危险因素、临床表现、影像学表现及实验室检查结果,分析椎-基底动脉系统脑梗死的临床特点。结果:(1)椎-基底动脉系统脑梗死占全部脑梗死的31.2%。(2)椎-基底动脉系统脑梗死最常见危险因素依次为高脂血症、高血压、糖尿病、饮酒、吸烟、心脏病史等。各个危险因素在不同梗死部位间,差异无统计学意义(P> 0.05)。椎-基底动脉系统脑梗死合并糖尿病的比例更高(P<0.05),差异有统计学意义;颈内动脉系统脑梗死心房颤动的比例更高(P<0.05),差异有统计学意义。(3)根据TOAST分型,最常见的病因为大动脉硬化性,其次为小动脉闭塞型。(4)常见症状和体征依次为肢体无力、头晕/眩晕、构音障碍、感觉障碍、共济失调、眼震、偏盲,吞咽困难/饮水呛咳。(5)好发部位是脑桥,其次为延髓、小脑、颞枕叶、丘脑、基底动脉尖、中脑,多发梗死较常见。(6)大脑后动脉狭窄最常见,其次是椎-基底动脉多发狭窄。椎-基底动脉系统脑梗死中伴椎-基底动脉狭窄患者的高血压,糖尿病,高脂血症比例均显著高于不伴椎基底动脉狭窄的患者,且NIHSS评分更高。结论:椎-基底动脉系统脑梗死患者具有高脂血症、高血压、糖尿病等主要危险因素;常见病因是大动脉粥样硬化性,其次为小动脉闭塞型;患者多合并糖尿病;桥脑是其好发部位;肢体无力、头晕/眩晕是其最常见的首发症状,典型的交叉症状或体征在椎-基底动脉系统脑梗死中较少见。伴椎-基底动脉狭窄的患者多合并高血压,糖尿病,高脂血症,临床症状更重。Objective:The aim of this study is to analyze the clinical features of acute vertebrobasilar system cerebral infarction by its comparing analysis of clinical data between acute internal carotid artery system and vertebrobasilar system cerebral infarction.Methods:The general data,risk factors,clinical manifestations,imaging and laboratory findings of patients with acute cerebral infarction(n=324) from Beijing Anzhen Hospital,Capital Medical University from February 2021 to July 2021 were analyzed retrospectively,to summarize the clinical characteristics of vertebrobasilar system cerebral infarction.Results:(1) Patients with vertebrobasilar infarction accounted for 31.2% of all patients with cerebral infarction.(2) The most common risk factors for cerebral infarction included hyperlipidemia,hypertension,diabetes mellitus,drinking,smoking,and heart disease.No significant difference in risk factors were found among patients with different Infarct sites(P>0.05).In patients with vertebrobasilar infarction diabetes mellitus was more frequent(P<0.05),while in patients with internal carotid artery system cerebral infarction,atrial fibrillation was more frequent(P< 0.05).(3) According to TOAST classification,the most common etiology is arteriosclerosis,followed by arteriolar occlusion.(4) The common symptoms and signs of vertebrobasilar system cerebral infarction were limb weakness,dizziness/vertigo,dysarthria,sensory disturbance,ataxia,nystagmus,hemianopia,dysphagia/choking cough.(5) The most common affected sites of vertebrobasilar system infarction was pons,followed by medulla oblongata,cerebellum,temporal occipital lobe,thalamus,tip of basilar artery and midbrain.Multiple infarctions of vertebrobasilar system is not unusual.6.Involvement of posterior cerebral artery stenosis was dominant,followed by multiple vessel stenosis of vertebrobasilar system.The proportion of hypertension,diabetes and hyperlipidemia in patients with vertebrobasilar artery stenosis in vertebrobasilar artery system cerebral infarction was signifi

关 键 词：椎-基底动脉系统脑梗死 颈内动脉系统脑梗死 危险因素 

分 类 号：R54[医药卫生—心血管疾病]