缺血型烟雾病术后脑梗死的血管构筑学危险因素分析  

Angioarchitectural risk factors associated with postoperative cerebral infarction in patients of ischemic moyamoya disease

作　　者：于腾飞 叶迅[2] 曾春[2] 陈晓霖[2] 赵元立[2] Yu Tengfei;Ye Xun;Zeng Chun;Chen Xiaolin;Zhao Yuanli(Department of Neurosurgery,Peking University International Hospital,Beijing 102206,China;Neurosurgery Center,Bejing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]北京大学国际医院神经外科,北京102206 [2]首都医科大学附属北京天坛医院神经外科学中心,北京100070

出　　处：《中华神经外科杂志》2023年第5期451-455,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨缺血型烟雾病患者血运重建术后脑梗死的血管构筑学危险因素.方法回顾性分析2015年10月至2020年10月于北京大学国际医院神经外科行血运重建术的缺血型烟雾病患者的临床资料,共418例(共行535例次手术,以下数据均按例次统计).其中261例(326例次)患者采用直接联合间接血运重建术(CR组),157例(209例次)患者采用间接血运重建术(EDAS组).分别比较两组术后1周内发生脑梗死与未发生脑梗死患者的性别、年龄、手术侧别,以及术前有短暂性脑缺血发作(TIA)、陈旧性脑梗死灶、颈内动脉(ICA)狭窄、大脑前动脉(ACA)A1段狭窄、大脑中动脉(MCA)M1段狭窄、大脑后动脉(PCA)病变、后循环代偿、不稳定代偿及颅外血管代偿占比的差异.将差异有统计学意义的指标纳入多因素logistic回归模型中进行分析.结果 326例次CR组中,术后1周内49例次(15.0%)发生脑梗死;209例次EDAS组中,术后38例次(18.2%)发生脑梗死.多因素logistic回归分析结果显示,年龄(OR=1.03,95%CI:1.00~1.07)、术前有TIA(OR=4.26,95%CI:1.84~9.86)、陈旧性脑梗死(OR=2.97,95%CI:1.19~7.40)、ACA A1 段狭窄(OR=5.84,95%CI:1.73~19.73)、MCA M1 段狭窄(OR=6.21,95%CI:2.08~18.53)、PCA 异常(OR=4.37,95%CI:1.45~13.13)及不稳定代偿(OR=5.34,95%CI:1.43~19.95)是缺血型烟雾病患者 CR术后脑梗死的危险因素(均P<0.05);年龄(OR=1.04,95%CI:1.01~1.06)、术前有陈旧性脑梗死(OR=2.89,95%CI:1.15~7.28)、ACA A1 段狭窄(OR=4.19,95%CI:1.59~11.07)及 PCA 异常(OR=2.78,95%CI:1.11~7.01)是缺血型烟雾病患者EDAS术后脑梗死的危险因素(均P<0.05).结论 术前血管构筑异常是缺血型烟雾病患者不同方式血运重建术后脑梗死的重要危险因素.Objective To investigate the angioarchitectural risk factors associated with postoperative cerebral infarction in patients with ischemic moyamoya disease(MMD).Methods The clinical data of 418 patients who underwent 535 surgical operations for ischemic MMD in the Department of Neurosurgery,Peking University International Hospital from October 2015 to October 2020 were retrospectively analyzed.Among them,261 patients underwent 326 operations by combined revascularization(CR group)and 157 patients underwent 209 operations by indirect revascularization(EDAS).The sex,age,side of surgery,TIA(transient ischemic attack),old cerebral infarction,and carotid artery(ICA)stenosis,ACA AI stenosis,MCA MI stenosis,posterior cerebral artery(PCA)anomaly,presence of posterior circulation compensation,unstable compensation and extracranial compensatory vascular structural factors were analyzed separately with the incidence of cerebral infarction within 1 week after surgery.Indexes with statistically significant differences were included in the multivariate logistic regression model for analysis.Results Cerebral infarction occurred in 49(15.0%)of 326 CR procedures and in 38(18.2%)of 209 EDAS procedures within 1 week after surgery.The results of multivariate logistic regression analysis showed that age(OR=1.03,95%CI:1.00-1.07),preoperative TIA(OR=4.26,95%CI:1.84-9.86),old cerebral infarction(OR=2.97,95%CI:1.19-7.40),ACA A1 stenosis(OR=5.84,95%CI:1.73-19.73),MCA M1 stenosis(OR=6.21.95%CI:2.08-18.53),PCA anomaly(OR=4.37,95%CI:1.45-13.13),and unstable compensation(OR=5.34,95%CI:1.43-19.95)were independent risk factors for cerebral infarction after CR surgery(all P<0.05).Age(OR=1.04,95%CI:1.01-1.06),old cerebral infarction(OR=2.89,95%CI:1.15-7.28),ACA A1 stenosis(OR=4.19,95%CI:1.59-11.07)and PCA anomaly(OR-2.78,95%CI:1.11-7.01)were independent risk factors for cerebral infarction after EDAS surgery(all P<0.05).Conclusion Preoperative angioarchitectural factors are important risk factors for cerebral infarction after various revascularizat

关 键 词：脑底异常血管网病 脑缺血 脑血管重建术 脑梗死 血管构筑学因素 

分 类 号：R651.12[医药卫生—外科学]