CT血管成像分析后循环脑梗死患者椎基底动脉不同节段病变  

Analysis of Vertebrobasilar Artery Segments in Posterior Circulation Cerebral Infarction Based on Computed Tomography Angiography

作　　者：张诗雨 孙如镜 程旭 乔鹏岗 ZHANG Shiyu;SUN Rujing;CHENG Xu;QIAO Penggang(Department of Radiology,Bejing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院放射科,北京100050

出　　处：《中国医学影像学杂志》2024年第9期878-883,共6页Chinese Journal of Medical Imaging

基　　金：北京市自然科学基金(7242043)。

摘　　要：目的基于CT血管成像分析后循环脑梗死(PCCI)患者椎基底动脉不同节段病变特点,研究其危险因素,提高早期识别率。资料与方法回顾性纳入首都医科大学附属北京友谊医院2022年1月—2023年3月199例急性脑梗死患者,分为PCCI组98例及前循环脑梗死组101例。比较两组椎动脉优势比例、椎基底动脉各节段狭窄发生率和狭窄程度的差异,并分析确定PCCI的危险因素。结果PCCI组椎动脉优势型比例(63.3%比48.5%)及基底动脉狭窄发生率(33.7%比20.8%)明显高于前循环脑梗死组(χ^(2)=4.387、4.174,P均<0.05)。两组间椎动脉V1段(Z=2.029,P=0.042)、V4段(Z=3.315,P=0.001)及基底动脉(Z=2.254,P=0.024)管腔狭窄程度差异有统计学意义,PCCI组重度狭窄/闭塞率较高。右侧椎动脉优势型(OR=4.285,95%CI 1.530~12.003)及右侧椎动脉V4段中-重度狭窄/闭塞(OR=5.883,95%CI 1.458~21.022;OR=5.537,95%CI 1.623~21.329)是发生PCCI的独立危险因素。结论PCCI与椎基底动脉形态学改变有关,右侧椎动脉优势型及右侧椎动脉V4段中-重度狭窄/闭塞发生PCCI的风险较高。Purpose To analyze the characteristics of different segments of vertebral-basilar artery lesions in posterior circulation cerebral infarction(PCCI)based on CT angiography,and to study its risk factors to improve the early recognition rate.Materials and Methods A total of 199 patients with acute cerebral infarction in Beijing Friendship Hospital,Capital Medical University from January 2022 to March 2023 were enrolled,retrospectively.98 with PCCI,and 101 with anterior circulation cerebral infarction.The groups were compared for differences in vertebral artery dominance,stenosis incidence and stenosis degree in the various vertebrobasilar artery segments.A binary Logistic regression analysis was applied to identify the risk factors for PCCI.Results The rate of vertebral artery dominance(63.3%vs.48.5%)and the incidence of basilar artery stenosis(33.7%vs.20.8%)were significantly higher in the PCCI group than in the anterior circulation cerebral infarction group(χ^(2)=4.387,4.174,both P<0.05).The groups differed significantly in the degree in the vertebral artery segments V1(Z=2.029,P=0.042)and V4(Z=3.315,P=0.001)and in the basilar artery(Z=2.254,P=0.024),with a higher percentage of severe stenosis in the PCCI group.Vertebral artery dominance(OR=4.285,95%CI 1.530-12.003)and right vertebral artery V4 segment moderate to severe stenosis/occlusion(OR=5.883,95%CI 1.458-21.022;OR=5.537,95%CI 1.623-21.329)were independent risk factors for PCCI.Conclusion PCCI is related to morphological changes of the vertebrobasilar artery,right vertebral artery dominance and moderate to severe stenosis/occlusion of V4 segment of right vertebral artery have a higher risk of PCCI.

关 键 词：脑梗死 椎动脉 基底动脉 CT血管造影术 危险因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R322.121[医药卫生—临床医学] R445.3