椎-基底动脉扩张延长症的临床特点研究

发布时间：2018-05-15 06:56

本文选题：椎-基底动脉扩张延长症 + 危险因素　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:椎-基底动脉扩张延长症(vertebrobasilar dolichoectasia,VBD)是指各种原因所致椎-基底动脉明显管腔扩张,延长移位。总体人群发生率低,但是卒中患者伴有VBD并不少见,且VBD伴有卒中患者致残率、死亡率较高,因此需要对其高度重视。本研究通过对VBD患者临床特点研究,加深对VBD的认识,提高VBD的早期诊断,减少漏诊、误诊率,控制可干预的危险因素,推迟并发症的发生。方法:1病例来源及分组选取自2014年6月至2014年10月在河北医科大学第二医院神经内科住院的经头颅CTA或核磁确诊为VBD合并脑梗死患者共40例,作为病例组,即VBD组。同期住院有其他明确病因而非VBD所致脑梗死患者50例,作为对照组。所有病例均符合1995年第四次全国脑血管疾病学术会议制定的各类脑血管疾病诊断要点,并于发病一周内入院。所有病例均排除风湿性心脏病、房颤、恶性肿瘤、全身严重感染、自身免疫性疾病、血液系统疾病以及肝、肾或心功能衰竭等。VBD的诊断标准,根据Smoker等[5]提出的VBD的CT诊断标准或Giang等[6]提出的MRI、MRA诊断标准。2记录所有病例一般资料(性别、年龄、既往病史、吸烟史、饮酒史)、实验室指标(血脂、同型半胱氨酸)、神经功能缺损程度及改善情况、临床表现、梗死部位、影像学特点以及最终治疗效果的比较,应用SPSS13.0软件对资料进行统计分析,计量资料采用t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果:1一般资料分析1.1性别及年龄病例组40例患者中,男性30例(75%),女10例(25%),平均年龄62.32±10.98岁,对照组50例患者中,男35例(70%),女15例(30%),平均年龄60.94±11.94岁,两组比较性别构成,年龄分布,无明显差异(P0.05)。1.2危险因素两组比较,高血压、糖尿病、冠心病、脑梗死、脑出血及吸烟饮酒史没有明显差异(P0.05);后循环TIA发作情况比较,两组之间没有差异(P0.05)。患者入院时均测定同型半胱氨酸,两组之间比较有统计学差异(P=0.01)。2临床特点2.1病例类型:病例组40例患者中,前循环梗死18例(45%),后循环梗死22例(55%);对照组50例患者中前循环梗死36例(72%),后循环梗死14例(28%),两组比较,后循环梗死有显著性差异(P0.05),提示VBD组患者更易发生后循环缺血。2.2临床表现:病例组40例患者中,肢体无力19例(47.5%),头晕15例(37.5%),后循环TIA病史者10例(25%),言语不清9例(22.5%),偏身感觉障碍4例(10%),头痛4例(10%),中枢性面瘫4例(10%),复视3例(7.5%),饮水呛咳2例(5%),三叉神经痛1例(2.5%),偏盲1例(2.5)。VBD组40例患者中属于轻度神经功能障碍(NIHSS4)者16例(40%),属于中度神经功能障碍者(NIHSS 4~15分)24例(60%),无重度神经功能障碍者(NIHSS15)。3影像学特征3.1梗死部位:VBD组内后循环梗死患者梗死部位分布情况:脑干16例(中脑1例,桥脑13例,延髓2例),小脑3例,枕叶2例,颞叶1例。提示VBD最易引起脑干梗死,且以桥脑为主。3.2椎-基底动脉受累情况及脑干受压情况:7例(17.5%)只累及基底动脉,13例(32.5%)累及双侧椎动脉,5例(12.5%)累及基底动脉及双侧椎动脉,12例(30%)累及基底动脉及单侧椎动脉,3例(7.5%)累及单侧椎动脉。17例患者存在不同程度脑干受压。4其他辅助检查VBD组与非VBD组在颈动脉彩超及心脏彩超对照无统计学差异(P值均0.05)。5 VBD组治疗:40例患者均按急性缺血性脑血管病给予抗血小板聚集、活血化瘀、神经保护等治疗,部分患者还给予了抗凝、扩容、脱水等治疗。6神经功能改善情况:病例组患者,基本治愈2例,显著进步2例,进步2例,无效34例,恶化0例,总有效率为15%。对照组患者,基本治愈4例,显著进步7例,进步8例,无效21例,恶化0例,总有效率为38%。两组比较有显著差异(P0.05)。提示VBD合并脑梗死患者治疗效果差,病情不易改善。结论:1 VBD组与非VBD组相比,在发病年龄,性别构成,血脂,血压,血糖,既往脑梗死,脑出血,病前TIA,发病时神经功能缺损程度没有明显差异。2 VBD组与非VBD组相比,高同型半胱氨酸血症发生率明显高,高同型半胱氨酸血症可能是VBD的危险因素。3 VBD组与非VBD组相比,VBD组后循环梗死发生率明显高于非VBD组,VBD是后循环缺血的危险因素。4 VBD组患者临床表现多样,无特异性。5在疗效方面,VBD组神经功能缺损恢复情况较非VBD组差,临床症状改善上也较非VBD组差,VBD合并脑梗死患者临床治疗效果差。
[Abstract]:Objective: vertebrobasilar dolichoectasia (VBD) refers to a variety of causes of the vertebrobasilar artery dilation and prolonged transposition. The overall population rate is low, but the incidence of VBD in stroke patients is not uncommon, and the mortality rate of VBD with stroke patients is high. Therefore, it is necessary to attach great importance to it. Through the study of the clinical characteristics of VBD patients, we can deepen the understanding of VBD, improve the early diagnosis of VBD, reduce the misdiagnosis, the rate of misdiagnosis, control the risk factors that can be intervened, and postpone the occurrence of complications. Methods: the 1 cases sources and groups were selected from June 2014 to October 2014 in the neurology department of the second hospital of Hebei Medical University. 40 cases of VBD combined with cerebral infarction were diagnosed by NMR as case group, that is group VBD. In the same period, 50 patients with other definite diseases and non VBD caused cerebral infarction were used as the control group. All cases were in line with the diagnosis points of various cerebrovascular diseases in the fourth national cerebral vascular Disease Conference in 1995 and hospitalized within one week of the onset of disease. All cases exclude rheumatic heart disease, atrial fibrillation, malignant tumor, systemic severe infection, autoimmune disease, blood system disease, and liver, kidney or heart failure, such as.VBD diagnostic criteria based on the CT diagnostic criteria of VBD or Giang such as Giang and [6], and MRA diagnostic standard.2 to record the general data of all cases (sex). Different age, past medical history, smoking history, drinking history), laboratory index (blood lipid, homocysteine), the degree and improvement of nerve function defect, clinical manifestation, infarct location, imaging characteristics and final therapeutic effect, SPSS13.0 software was used to analyze the data, the measurement data were t test, and the count data were used chi 2 The difference was statistically significant. Results: 1 general data: 1 general data analysis of 40 cases of 1.1 sex and age cases, male 30 (75%), 10 women (25%), average age 62.32 + 10.98 years, 50 patients in the control group, 35 (70%), female 15 (30%), average age and age, the group compared sex composition, age distribution, no significant difference There was no significant difference in the two groups of P0.05.1.2 risk factors. There was no significant difference in hypertension, diabetes, coronary heart disease, cerebral infarction, cerebral hemorrhage and smoking and drinking history (P0.05). There was no difference between the two groups (P0.05) in the case of TIA seizures in the posterior circulation (P0.05). There was a statistically significant difference between the two groups (P=0.01) the clinical characteristics of.2 2.1. Case type: among 40 cases of case group, 18 cases of anterior circulation infarction (45%), 22 cases of posterior circulation infarction (55%), 36 cases of anterior circulation infarction (72%) in 50 cases of control group, 14 cases of posterior circulation infarction (28%), and significant difference in posterior circulation infarction (P0.05) in the two group (P0.05), suggesting that patients in group VBD were more likely to have clinical manifestations of posterior circulation ischemia.2.2: case group 40 patients Among them, there were 19 cases of limb weakness (47.5%), 15 cases of dizziness (37.5%), 10 cases of posterior circulation TIA (25%), 9 cases (10%), 4 cases of partial feeling disorder (10%), 4 (10%) headache, central facial paralysis, recurrent cough, trigeminal neuralgia and mild nerve work in group.VBD. There were 16 (40%) patients with disability (NIHSS4), 24 cases (60%) of moderate nerve dysfunction (NIHSS 4~15), and 3.1 infarct sites with.3 imaging features without severe neurological dysfunction (NIHSS15): the distribution of Infarct Sites in group VBD patients with posterior circulation infarction: 16 cases of brain stem (1 cases in the middle brain, 13 cases of pontine, 2 cases of medulla oblongata), 3 cases in cerebellum, 2 in occipital lobe and 1 in temporal lobe. It was suggested that VBD was the most likely cause of brain stem infarction, and the main.3.2 vertebral basilar artery involvement in the bridge brain and the pressure of the brain stem: 7 cases (17.5%) only involve the basilar artery, 13 cases (32.5%) involve bilateral vertebral artery, 5 cases (12.5%) involve the basilar artery and bilateral vertebral artery, 12 cases (30%) involve the basilar artery and the unilateral vertebral artery, 3 cases (7.5%) involve the unilateral vertebral artery. .17 patients had different degree of brain stem compression and.4 other auxiliary examination of VBD group and non VBD group in carotid artery color Doppler ultrasound and heart color ultrasound control no statistically significant difference (P value 0.05).5 VBD group treatment: 40 patients were treated with acute ischemic cerebrovascular disease to give anti platelet aggregation, blood activating and blood stasis, neuroprotection and other treatment, some patients also gave resistance. Coagulation, dilatation, dehydration and other treatment of.6 nerve function improvement: case group patients, basic cure 2 cases, significant progress in 2 cases, 2 cases, 34 cases, 0 cases of deterioration, the total effective rate is 15%. control group, the basic cure 4 cases, significant progress 7 cases, 8 cases, 21 cases, 0 cases, the total effective rate of group 38%. two is significant difference (P0.05). The treatment effect of VBD combined with cerebral infarction was poor and the condition was not easy to improve. Conclusion: 1 VBD group compared with non VBD group, the age of onset, sex composition, blood lipid, blood pressure, blood sugar, previous cerebral infarction, cerebral hemorrhage, TIA before the disease, there was no significant difference between.2 VBD and non VBD group, the incidence of hyperhomocysteinemia was compared with the non VBD group. Significantly higher, hyperhomocysteinemia may be a risk factor for VBD in the.3 VBD group and the non VBD group. The incidence of posterior circulation infarction in the VBD group was significantly higher than that in the non VBD group. VBD was a risk factor for the posterior circulation ischemia in the group.4 VBD, and there was no specific.5 in the curative effect, and the recovery of the neurological function in VBD group was worse than that of the non VBD group. The improvement of bed symptoms was also worse than that of non VBD group. The clinical efficacy of VBD combined with cerebral infarction was poor.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3

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