成年人烟雾病的卒中类型、部位及脑血管病变、侧支循环代偿的研究

摘要

Objective To investigate the stroke types, localizations and cerebrovescular lesion and collateral circulation compensation in adult moyamoya disease (MMD). Methods The clinical data of 41 patients with MMD were analyzed retrospectively. Results In all 41 patients, 25 cases (61% ) were cerebral hemorrhagic stroke (CHS) and 16 cases (39% ) were cerebral ischemic stroke (CIS). The ratio of stroke localizations on ventricle or around (based ganglia region) in CHS patients (64%) was significantly higher than that in CIS patients (25%) (P< 0. 05 ). The ratio of stroke localizations on cortical or subcortex zone in CIS patients (75 % ) was significantly higher than that in CHS patients ( 12% ) ( P < 0. 01 ). There were 82 branches of vascular lesions confirmed by cerebral digital subtraction angiography, and the ratio of vascular lesions in internal carotid artery (76. 8% ) was significantly higher than in middle cerebral artery (17. 1% ) and in anterior cerebral artery (6. 1% ) (all P <0. 05) . The ratio of collateral circulation of deep perforating branch (78 branches,95. 1% ) , Willis circle (51 branches, 62. 2% ) , meningeal branch ( 62 branches ,75. 6% ) , corpus callosum posterior artery (50 branches ,61. 0% ) were significantly higher than ophthalmic artery (19 branches 23. 1% ) and middle meningeal artery (9 branches 10.9%) ( all P < 0. 01). The difference of vascular lesions and lateral branch compensation between CHS patients and CIS patients were no statistical significance. The ratios of stage V and VI of Suzuki grades in CIS patients were significantly higher than that in CHS group (all P < 0. 05 ). Conclusions CHS is multiple in adult MMD patients and hemorrhagic localizations are most in ventricle or periventricular zones. Cortical and subcortical zones are mainly stroke localizations in CIS patients. The mainly collateral circulations are include deep perforating branch, Willis circle, meningeal branch and corpus callosum posterior artery.%目的 研究成年人烟雾病(MMD)的卒中类型、部位及脑血管病变和侧支循环代偿.方法 回顾性分析41例成年MMD患者的临床资料.结果 41例患者中,出血性脑卒中(CHS) 25例(61％),缺血性脑卒中(CIS) 16例(39％).CHS患者卒中部位在脑室及其周围(基底节区)的比率(64％)显著高于CIS患者(25％) (P＜0.05)；CIS患者卒中部位在皮质或皮质下的比率(75％)显著高于CHS患者(12％)(P＜0.01).数字减影血管造影发现脑血管病变82支,其中颈内动脉(ICA)病变的比率(76.8％)显著高于大脑中动脉(MCA)(17.1％)和大脑前动脉(ACA)(6.1％)(均P＜0.05)；深穿支(78支,95.1％)、Willis环(51支,62.2％)、脑膜支(62支,75.6％)和胼周后动脉(50支,61.0％)代偿的比率显著高于眼动脉(19支,23.1％)和脑膜中动脉(9支,10.9％)(均P＜0.01).CHS与CIS患者脑血管病变部位、代偿方式的差异无统计学意义；CIS患者脑血管Suzuki分级V级、Ⅵ级的比率显著高于CHS组(均P＜0.05).结论 成人MMD以CHS多发,并多发生在脑室及其周围；CIS的卒中部位以皮质、皮质下区为主.MMD的主要代偿方式为深穿支、Wilis环、脑膜支、胼周后动脉代偿.