椎基底动脉延长迂曲症患者临床特征及并发急性脑梗死相关危险因素分析

摘要

Objective To investigate the clinical and imaging features of vertebrobasilar dolichoectasia (VBD),and to find risk factors related to the occurrence of acute cerebral infarction in VBD patients.Methods Twenty-one patients who were di-agnosed as having VBD with the use of digital subtraction angiography (DSA)and treated in Wuhan Tongji Hospital from Au-gust 2012 to June 2017 were selected.Their clinical manifestations and imageological examination results were retrospectively analyzed.Logistic regression analysis was used to analyze the risk factors related to acute cerebral infarction in VBD pa-tients.Results The onset symptom was cerebral infarction stroke in 15 patients,brainstem and cranial nerves compression in 4 patients,and cerebral hemorrhage in 2 patients.Analysis of the location of lesions in 13 patients complicated with acute cerebral infarction found that the lesions lied in the posterior circulation territory in 9 patients and in the inferior circulation territory in 4 patients.VBD patients with smoking,hypertension or elevated D-dimmer levels were more likely to develop acute cerebral in-farction.Conclusion DSA performed in patients with posterior cerebral circulation infarction elevates the detection rate of VBD;the elevated D-dimmer level is an independent risk factor for acute cerebral infarction in VBD patients.%目的 研究椎基底动脉延长迂曲症(vertebrobasilar dolichoectasia,VBD)的临床表现及影像学特点,并探讨影响VBD患者发生急性脑梗死的相关危险因素.方法 收集2012年8月~2017年6月在武汉同济医院住院治疗,采用数字减影血管造影(digital subtraction angiography,DSA)确诊的VBD患者21例.对其临床表现、影像学检查结果进行回顾性分析,并采用Logistics回归分析探讨影响VBD患者发生急性脑梗死的相关危险因素.结果 21例患者中首发症状为脑梗死者15例,脑干或颅神经压迫4例,脑出血2例.对其中13例急性脑梗死患者进行病灶定位分析发现,病灶位于前循环者为4例、后循环者9例.临床合并吸烟、高血压以及较高D-D二聚体水平的VBD患者更容易发生急性脑梗死.结论 对临床表现为后循环梗死的患者进行头颅影像学检查(如DSA)可以增加VBD的检出率,D-D二聚体升高为VBD患者发生急性脑梗死的独立危险因素.