椎基底动脉延长扩张症与脑卒中关系的临床分析

发布时间：2018-05-20 15:10

本文选题：椎基底动脉扩张延长症 + 脑卒中　；参考：《浙江大学》2014年硕士论文

【摘要】：背景和目的：椎基底动脉延长扩张症(vertebrobasilar dolichoectasia,VBD)是目前尚处于临床研究和探索阶段的一种特殊的脑血管变异性疾病。随着医学影像学的发展,人们对该疾病的认识逐渐增多。本文研究的目的是分析椎基底动脉延长扩张症的影像学表现,以及与脑卒中主要临床资料的关系,为临床早期诊断及早期治疗提供参考依据。方法：回顾性分析2012年12月至2013年5月在浙江大学医学院附属第二医院神经内科住院的脑卒中患者,经影像学检查确诊,均符合第四届全国脑血管疾病诊断标准,排除脑实质及其他器质性疾病。记录患者的临床资料(年龄、性别、烟酒嗜好、高血压、糖尿病、高脂血症、肥胖、冠心病、既往脑卒中病史)、通过头颅CT、头颅MRI或头颅MRA检查,从影像学表现(具体病变部位、椎基底动脉管径大小、分叉高度、偏移程度)上进行VBD判断。依据VBD的诊断标准[2-4]将入选患者分为VBD组和非VBD组。所有的数据资料使用统计软件SPSS17.0进行分析。结果： 1.入选病例共计772例,脑梗死患者558例,脑出血患者214例。VBD患者45例,占同期急性脑卒中患者的5.8%,其中伴有VBD的脑梗死患者33例,占脑梗死病例5.9%,伴有VBD的脑出血患者12例,占脑出血病例5.6%。 2.共有45例VBD患者,727例非VBD患者,对VBD组与非VBD组临床资料比较,两组发现男性(χ2=3.875,P0.05)、肥胖(x2=5.243,P0.05)、吸烟史(x2=4.213,P0.05)有统计学差异,而年龄(t=1.245,P0.05)、高血压(x2=0.274,P0.05)、糖尿病(χ2=0.966,P0.05)、高脂血症(χ2=0.974,P0.05)、冠心病史(χ2=0.184,P0.05)、脑卒中史(χ2=0.012,P0.05)无统计学差异。 3.45例VBD患者,根据影像学检查,33例VBD伴脑梗死患者基底动脉直径平均为5.04±0.27mm,椎动脉直径平均为4.55±0.16mm,基底动脉分叉高度评级平均为1.45±0.56,基底动脉水平移位评级平均为1.33±0.48,而12例VBD伴脑出血患者基底动脉直径平均为5.13±1.00mm,椎动脉直径平均为4.48±0.40mm,基底动脉分叉高度评级平均为2.08±0.51,基底动脉水平移位评级平均为1.25±0.45。VBD患者脑出血组基底动脉分叉高度明显高于脑梗死组(P0.05)。 4.伴VBD脑梗死组与腔隙性梗死及脑干梗死密切相关,伴VBD脑出血组与脑干出血密切相关,其临床表现与梗死或出血部位有关。结论： 1.VBD在脑梗死与脑出血中发病率差别不大。 2.VBD脑卒中的发生与男性,吸烟及肥胖密切相关。 3.基底动脉分叉高度与VBD脑出血的发生密切相关。 4.多种影像学检查手段可提高VBD的临床诊断率。
[Abstract]:Background and purpose: Vertebrobasilar dolichoectasia VBDD (vertebrobasilar dolichoectasia VBDD) is a special cerebrovascular variability disease which is still in the stage of clinical research and exploration. With the development of medical imaging, people's understanding of the disease is gradually increasing. The purpose of this study is to analyze the imaging features of vertebrobasilar artery dilatation and its relationship with the main clinical data of stroke, and to provide reference for early diagnosis and treatment of vertebrobasilar artery dilatation. Methods: From December 2012 to May 2013, the stroke patients hospitalized in the Department of Neurology, second affiliated Hospital of Zhejiang University Medical College, who were diagnosed by imaging examination, met the diagnostic criteria of the fourth National Cerebrovascular Disease. Exclude brain parenchyma and other organic diseases. Clinical data (age, sex, smoking and alcohol addiction, hypertension, diabetes, hyperlipidemia, obesity, coronary heart disease, past stroke history) were recorded. VBD was performed on imaging findings (location of lesion, diameter of vertebrobasilar artery, height of bifurcation, degree of deviation). Patients were divided into VBD group and non-VBD group according to the diagnostic criteria of VBD [2-4]. All data are analyzed using statistical software SPSS17.0. Results: 1. There were 772 patients with cerebral infarction, 558 patients with cerebral infarction and 45 patients with cerebral hemorrhage, accounting for 5.8% of the acute stroke patients in the same period. Among them, 33 cases were cerebral infarction patients with VBD, accounting for 5.9% of cerebral infarction cases, and 12 cases were cerebral hemorrhage patients with VBD. Accounting for 5.6% of cerebral hemorrhage. 2. There were 45 patients with VBD and 727 patients with non-VBD. There was a significant difference between the two groups in the clinical data of VBD group and non-VBD group (蠂 2 + 3.875% P 0.05, obesity 5.243% P 0.05, smoking history 24. 213% P 0.05), and there was a significant difference between the two groups in the clinical data of VBD group and non-VBD group (蠂 2 + 3.875%, P 0.05, P 0.05). However, there was no significant difference in age, hypertension, diabetes, hyperlipidemia, coronary heart disease (蠂 2, 0.184, P 0.05, 蠂 2, 0.184, P 0.05, 蠂 20.012, P 0.05), diabetes (蠂 2, 0.966, P 0.05, 蠂 2, 0.974, P 0.05, 蠂 2, 0.184, P 0.05, 蠂 2, 0. 012, P 0. 05, 蠂 2. 012, P 0. 05, 蠂 2, P 0. 05, 蠂 2, 0. 184, P 0. 05, 蠂 2 = 0. 184, P 0. 05). 3.45 patients with VBD, The average diameter of basilar artery, vertebral artery, basilar artery and basilar artery were 5.04 卤0.27 mm, 4.55 卤0.16 mm, 1.45 卤0.56 and 1.33 卤0.48 in 33 VBD patients with cerebral infarction according to imaging examination. The average diameter of basilar artery, vertebral artery and basilar artery were 5.13 卤1.00mm, 4.48 卤0.40mm and 2.08 卤0.51mm, respectively. The average horizontal transposition grade of basilar artery in patients with cerebral hemorrhage was significantly higher than that in patients with cerebral infarction (P 0.05). 4. VBD cerebral infarction group was closely related to lacunar infarction and brainstem infarction, and VBD cerebral hemorrhage group was closely related to brainstem hemorrhage, and its clinical manifestation was related to infarct or location of hemorrhage. Conclusion: There was no significant difference in the incidence of 1.VBD between cerebral infarction and cerebral hemorrhage. The incidence of 2.VBD stroke is closely related to men, smoking and obesity. 3. The height of basilar artery bifurcation is closely related to the occurrence of VBD intracerebral hemorrhage. 4. A variety of imaging methods can improve the clinical diagnosis rate of VBD.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

【共引文献】