椎动脉发育不良与急性单发后循环梗死患者梗死部位和椎-基底动脉形态及斑块特征关系的研究  

Association between vertebral artery hypoplasia and infarct site and vertebrobasilar artery morphology or plaque characteristics in patients with acute single posterior circulation cerebral infarction

作　　者：孙宜永 闫鹏[1] 李珊 李继锋[1] 孙钦建[1] Sun Yiyong;Yan Peng;Li Shan;Li Jifeng;Sun Qinjian(Department of Neurology,Shandong Provincial Hospital,Ji′nan 250021,China)

机构地区：[1]山东省立医院神经内科,济南250021 [2]淄博市市立医院神经内科

出　　处：《中国脑血管病杂志》2023年第4期230-238,247,共10页Chinese Journal of Cerebrovascular Diseases

基　　金：济南市临床医学科技创新计划(201704101)。

摘　　要：目的 探讨椎动脉发育不良与急性单发后循环梗死部位、椎-基底动脉形态及斑块特征的关系。方法 回顾性连续纳入2013年3月至2020年12月山东省立医院神经内科首次住院的急性单发性后循环梗死患者477例。根据DSA检查结果,将477例分为椎动脉发育不良组(209例)和椎动脉发育正常组(268例);根据脑梗死存在的侧别,将椎动脉发育不良组进一步分为椎动脉发育不良侧(椎动脉发育不良与脑梗死同侧,127例)和椎动脉发育正常侧(椎动脉发育正常与脑梗死同侧,82例)。比较两组患者年龄、性别、体质量指数、吸烟史、高血压病史、糖尿病史、冠心病史以及基线血压、空腹血糖、低密度脂蛋白、同型半胱氨酸、尿酸、肌酐、纤维蛋白原水平、后循环梗死部位(近、中、远段)、基底动脉弯曲度指数、基底动脉弯曲凸向、椎动脉颅内段狭窄、椎动脉开口角度、胚胎型大脑后动脉的差异。比较两组椎动脉颅内段责任斑块特征[斑块面积、斑块负荷、重构指数、血管重构模式(正性重构、负性重构和无明显重构)、斑块强化程度(无强化、轻度强化、明显强化)、斑块形态(偏心性斑块和向心性斑块)]。结果 (1)两组患者年龄、性别、体质量指数、吸烟史、高血压病史、糖尿病史、冠心病史以及基线血压、空腹血糖、低密度脂蛋白、同型半胱氨酸、尿酸、肌酐、纤维蛋白原水平的差异均无统计学意义(均P>0.05)。(2)椎动脉发育不良组近段、中段、远段梗死占比分别为22.0%(46/209)、40.7%(85/209)、37.3%(78/209),椎动脉发育正常组近段、中段、远段梗死占比分别为13.1%(35/268)、45.1%(121/268)、41.8%(112/268),两组梗死部位分布的差异有统计学意义(χ^(2)=6.674,P=0.036)。椎动脉发育不良组中,椎动脉发育不良侧近段、中段、远段梗死占比分别为27.6%(35/127)、35.4%(45/127)、37.0%(47/127),椎动脉发育正常侧近段�Objective To investigate the relationship between vertebral artery hypoplasia(VAH)and infarct location,vertebrobasilar artery morphology and plaque features of acute single posterior circulation cerebral infarction.Methods A total of 477 patients with acute single posterior circulation infarction who were hospitalized for the first time in the Department of Neurology of Shandong Provincial Hospital from March 2013 to December 2020 were retrospectively included.According to the results of DSA examination,477 patients were divided into the VAH group(209 cases)and the non-VAH group(268 cases).According to the side of cerebral infarction,the VAH group was further divided into the side of VAH(VAH and cerebral infarction on the same side,127 cases)and the side of non-VAH(non-VAH and cerebral infarction on the same side,82 cases).Age,sex,body mass index,smoking history,hypertension history,diabetes history,coronary heart disease history,baseline blood pressure,fasting blood glucose,low-density lipoprotein,homocysteine,uric acid,creatinine,fibrinogen,posterior circulation infarct site(proximal,middle and distal segment),basilar artery curvature index,basilar artery curvature and protrusion,vertebral artery intracranial stenosis,vertebral artery ostium angle,embryonic posterior cerebral artery were compared between the two groups.The plaque characteristics(plaque area,plaque load,remodeling index,mode of vascular remodeling[positive remodeling,negative remodeling and non-remodeling],degree of plaque enhance ment[no enhancement,mild enhancement,significant enhancement],and plaque morphology[eccentric and concentric])were compared between the two groups.Results(1)There was no significant difference in age,sex,body mass index,smoking history,hypertension history,diabetes history,coronary heart disease history,baseline blood pressure,fasting blood glucose,low-density lipoprotein,homocysteine,uric acid,creatinine,fibrinogen levels between the two groups(all P>0.05).(2)The proportion of proximal,middle and distal infarcts in th

关 键 词：椎动脉供血不足 椎动脉发育不良 脑梗死 斑块特征 

分 类 号：R743.33[医药卫生—神经病学与精神病学]