成人烟雾病的临床和影像学分析

发布时间：2018-03-21 00:14

本文选题：成人烟雾病　切入点：流行病学　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的分析成人烟雾病患者的流行病学、病理、临床表现、影像学特征、治疗方法以及转归等,旨在加深对该病的认识,为临床诊治提供参考依据。方法 1.回顾性收集2003年4月～2013年4月间在天津市环湖医院住院治疗的57例成人烟雾病患者的临床和影像学资料。 2.将发生缺血性脑血管病事件的患者归为缺血组,将发生出血性脑血管病事件的患者归为出血组。比较两组患者的流行病学、临床表现、病变血管、脑动脉瘤、出院转归情况等差异。 3.总结成人烟雾病患者头颅CT、MRI表现,并分析头颅MRA对该病的诊断价值。 4.评估脑血管重建术对成人烟雾病的治疗效果。 5.全部数据采用SPSS19.0统计软件进行处理。所有统计均采用双侧检验,统计推断的检验水准为a=0.05,P0.05时认为差异有统计学意义。结果 1.患者平均36.42±10.85岁,男女比例1：1.48,来自天津及周边地区,均为汉族,0人有家族史。缺血组和出血组平均年龄、年龄组成、性别、发病季节差异无统计学意义。缺血组吸烟比例高于出血组,差异有统计学意义。5.3%患者存在特殊病史,10.5%患者发病前有明显诱因。 2.病理显示：1例颞浅动脉管壁增厚,管腔狭窄,局部钙盐沉积,免疫组化CD34、抗平滑肌抗体阳性；1例硬脑膜小动脉内膜部分增生,部分剥脱,小静脉扩张,局部出血；1例硬脑膜及少许软脑膜轻度增厚。 3.患者最常见的临床表现依次为头痛头晕、肢体运动障碍、视觉异常、肢体感觉异常,语言障碍、意识障碍。缺血组视觉异常、肢体运动障碍比例高于出血组,出血组头痛头晕、意识障碍比例高于缺血组,出血组入院NIHSS评分和住院期间最高NIHSS评分高于缺血组,差异有统计学意义。 4.6例患者风湿免疫全项均大致正常。 5.缺血组30.4%患者存在脑萎缩,梗死灶93.1%患者位于一侧大脑半球,37.9%患者累及后循环,69.0%患者为多发性斑点状,不符合常规血管分布。出血组13.0%患者存在脑萎缩,21.7%患者存在多发腔隙性梗死灶伴软化灶,出血部位56.5%患者累及脑实质,52.2%患者累及脑室,30.4%患者累及蛛网膜下腔。 6.缺血组大脑后动脉狭窄(或闭塞)比例高于出血组,差异有统计学意义,两组大脑后动脉分期差异亦有统计学意义。两组Suzuki分期差异无统计学意义。出血组脑动脉瘤比例高于缺血组,差异有统计学意义,且脑动脉瘤是成人出血型烟雾病的危险因素。 7.MRA诊断颈内动脉C1段、大脑前动脉A1段、大脑中动脉M1段、大脑后动脉P1段狭窄(或闭塞)的阳性预测值为55.8%-90.1%,阴性预测值为45.9%-88.5%,灵敏度为75.3%-97.2%,特异度为40.0%-76.8%,正确率为78.6%-93.8%。MRA1级患者Suzuki分期表现为Ⅰ期、Ⅱ期,MRA2级患者对应Suzuki分期Ⅱ期、Ⅲ期、Ⅳ期,MRA3级患者对应Suzuki分期Ⅱ期、Ⅳ期,MRA4级患者对应Suzuki分期V期、Ⅵ期。在代偿血管显影方面MRA视脉络膜后动脉、胼周后动脉、眼动脉与DSA差别不大,其他小血管常显示不清。 8.缺血组和出血组出院NIHSS评分差异无统计学意义。患者行脑血管重建术后6月mRS评分低于术前,差异有统计学意义。患者术后数天～20月复查血管影像显示均已建立颈外动脉系统至颈内动脉系统交通支。结论 1.本资料显示成人烟雾病好发于青中年患者,男女比例1：1.48； 2.脑动脉瘤是成人出血型烟雾病的危险因素； 3.成人烟雾病常见临床表现依次为头痛头晕、肢体运动障碍、视觉异常、肢体感觉异常,缺血型患者更易出现肢体运动障碍、视觉异常； 4.成人烟雾病患者梗死灶常呈多发性,不符合常规血管分布,出血易累及侧脑室,诊断依赖血管影像学检查,除DSA外,MRA亦能作为诊断标准； 5.除一般内科治疗外,患者可考虑行脑血管重建术。
[Abstract]:objective
Objective to analyze the epidemiology, pathology, clinical manifestations, imaging features, treatment and outcome of adult moyamoya disease, so as to deepen our understanding of the disease and provide a reference for clinical diagnosis and treatment.
Method
1. the clinical and imaging data of 57 adult moyamoya patients hospitalized in Tianjin Huanhu Hospital from April 2003 to April 2013 were retrospectively reviewed.
2., patients with ischemic cerebrovascular disease were classified as ischemic group. Patients with hemorrhagic cerebrovascular disease were classified as bleeding group. The epidemiology, clinical manifestations, pathological vessels, cerebral aneurysms and discharge outcomes of two groups were compared.
3. to summarize the CT and MRI manifestations of the head of adult moyamoya disease, and to analyze the diagnostic value of skull MRA for the disease.
4. to evaluate the therapeutic effect of cerebral vascular reconstruction in adult moyamoya disease.
5., all data were processed by SPSS19.0 statistical software. All the statistics were tested by bilateral test. The statistical inference level was a=0.05, P0.05. The difference was statistically significant.
Result
1. patients with an average of 36.42 + 10.85 years, the proportion of male and female 1:1.48, from Tianjin and the surrounding areas, are Han nationality, 0 people with a family history of ischemic group and the hemorrhage group. The average age, age, gender, no significant seasonal differences. The smoking rate is higher than the ischemia group hemorrhage group, the difference was statistically significant in patients with.5.3% special history, 10.5% have obvious incentives before the onset of disease.
2. pathological examination showed: 1 cases of superficial temporal artery wall thickening, stenosis, partial deposition of calcium salt, immunohistochemical CD34, anti smooth muscle antibody positive; 1 cases of dural arterial intimal hyperplasia, partial exfoliation, small vein dilatation, local hemorrhage; 1 cases of dural and pial a mild thickening.
The most common clinical manifestations of 3. patients were headache and dizziness, limb movement disorder, abnormal vision, acroparesthesia, language disorder, disorder of consciousness. In ischemic group, abnormal vision, limb movement disorder is higher than the proportion of bleeding group, hemorrhage group headache, disturbance of consciousness was higher than that of ischemic group, hemorrhage group NIHSS score on admission and during hospitalization, the highest NIHSS the score is higher than that of ischemic group, the difference was statistically significant.
All 4.6 cases of rheumatic immunization were generally normal.
The 5. group of 30.4% patients with ischemic cerebral atrophy, 93.1% patients with cerebral infarction located in cerebral hemisphere, 37.9% patients with posterior circulation, 69% patients with multiple spots, do not conform to the normal distribution. The vascular hemorrhage group 13% patients had cerebral atrophy, 21.7% patients with lacunar infarcts with encephalomalacia, bleeding in 56.5% patients involving the brain parenchyma, 52.2% patients involving 30.4% patients with ventricle and subarachnoid space.
6. ischemia group (posterior cerebral artery stenosis or occlusion) is higher than the hemorrhage group, the difference was statistically significant, the two group stage posterior cerebral artery. There was significant difference between the two groups had no statistically significant difference in bleeding group. Suzuki staging of cerebral aneurysms is higher than the proportion of the ischemia group, the difference was statistically significant, and the cerebral aneurysm is adult moyamoya disease risk factors.
7.MRA diagnosis of C1 segment of internal carotid artery, anterior cerebral artery A1 segment, M1 segment of middle cerebral artery, posterior cerebral artery P1 segment stenosis (or block) of the positive predictive value and negative predictive value of 55.8%-90.1%, 45.9%-88.5%, sensitivity is 75.3%-97.2%, the specificity of 40.0%-76.8% II, the correct rate is 78.6% -93.8%.MRA1 with Suzuki stage performance the first stage, patients with grade MRA2 corresponding to Suzuki stage II, III, IV, MRA3 with corresponding Suzuki stage II, stage IV patients with grade MRA4, corresponding to Suzuki stage V, stage VI. In developing the MRA optic compensatory vessels posterior choroidal artery pericallosal artery, ophthalmic artery had little difference DSA and other small vessels is often unclear.
8. ischemia group and bleeding group NIHSS score between the discharge was not statistically significant. Patients with cerebral revascularization after June mRS score lower than before, the difference was statistically significant. Postoperative days to 20 months of vascular image display have been established for the external carotid artery to internal carotid artery system traffic.
conclusion
1. the data showed that adult moyamoya disease was found in middle-aged and middle-aged patients with a ratio of 1:1.48 to men and women.
2. cerebral aneurysm is a risk factor for adult moyamoya disease.
3., the common clinical manifestations of adult moyamoya disease are headache, dizziness, limb movement disorder, visual abnormality, limb sensation abnormality, and patients with ischemic type are more likely to have limb movement disorders and abnormal vision.
4. adult patients with moyamoya disease often have multiple infarcts, which do not conform to routine blood vessel distribution. Bleeding is easy to involve the lateral ventricle. Diagnosis depends on vascular imaging. Besides DSA, MRA can also be used as a diagnostic standard.
5. in addition to general medical treatment, the patient may consider revascularization of the brain.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

【参考文献】