Graves病合并烟雾病1例报告并临床特征分析

发布时间：2018-11-20 12:36

【摘要】：背景：Graves病烟雾病是一种慢性进展的脑血管疾病,病因不明,特点是双侧颈内动脉远端严重狭窄或闭塞,同时伴随脑底部和软脑膜烟雾状毛细血管网形成。Graves病是一种自身免疫疾病,以体内过多的甲状腺激素为特点。近几年国内外仅有少量关于Graves病合并烟雾病的报道,认为两者之间可能存在一定关系,但尚未明确。目的：研究Graves并合并烟雾病的发病机制及二者关系,探讨其临床特点及治疗策略。方法：对1例确诊为Graves病合并烟雾病患者的临床资料进行报道,并检索中国知网、Pubmed、万方数据库自1991年至今收录发表的资料较完整的甲亢合并烟雾病的临床病例报道和病例分析,进行甲亢合并烟雾病的发病机制及临床特征的探讨。结果：Graves病合并烟雾病的报道较少,由Kushima等于1991年首次报道二者合并,亚洲人发病率高于欧美,通过相关文献,总结如下：青年女性发病率明显高于其他年龄性别的患者,有遗传倾向,多于甲状腺毒症期间发作烟雾病,Graves病合并烟雾病的发病机制目前主要考虑有自身免疫反应、血流动力学异常、遗传因素、动脉粥样硬化四个因素,但因研究报道较少,目前仍不能明确。颅脑影像学检查脑梗死表现明显多于脑出血,血管造影双侧明显多余单侧,多伴烟雾状血管网,烟雾病的病情与甲状腺功能明显相关,烟雾病发病多处在甲功亢进状态,甲状腺功能改善,脑卒中病情好转。抗甲亢治疗降低脑代谢,联合神经系统治疗改善症状,脑膜颞浅动脉血管融通术可使颅外向颅内增加血液代偿,血管重建术可能是预防脑卒中的有效方法。结论：Graves病与烟雾病的发病机制有一定联系,前者直接影响烟雾病的病情变化,体内甲状腺素水平的突然变化可引起脑缺血性卒中,控制甲亢,烟雾病症状得到改善。对于脑底动脉闭塞的年轻患者,无论是否有甲亢症状,都有必要进行甲状腺功能检测,同时行MRA或DSA协助早期诊断。
[Abstract]:Background: moyamoya disease is a chronic progressive cerebrovascular disease with unknown etiology characterized by severe stenosis or occlusion of the distal end of bilateral internal carotid artery. Graves's disease is an autoimmune disease characterized by excessive thyroid hormones. In recent years, there are only a few reports about Graves's disease combined with moyamoya disease at home and abroad. It is considered that there may be a certain relationship between the two diseases, but it is not clear. Objective: to study the pathogenesis and the relationship between Graves and moyamoya disease, and to explore its clinical features and treatment strategies. Methods: the clinical data of a case of Graves's disease complicated with moyamoya disease were reported and searched for Pubmed,. The clinical case report and case analysis of hyperthyroidism combined with moyamoya disease were published in Wanfang database from 1991 to present. The pathogenesis and clinical characteristics of hyperthyroidism combined with moyamoya disease were discussed. Results: there were few reports of Graves's disease associated with moyamoya disease. Kushima was the first to report the combination of the two diseases in 1991. The incidence rate of Asian people was higher than that of Europe and the United States. According to the relevant literature, the incidence rate of young women was significantly higher than that of patients of other age and sex. The pathogenesis of Graves's disease with moyamoya disease mainly includes autoimmune response, hemodynamic abnormality, genetic factors and atherosclerosis. However, due to the lack of research reports, it is still not clear. Craniocerebral imaging examination showed that cerebral infarction was obviously more than cerebral hemorrhage, bilateral angiography was obviously superfluous on one side, and most of them were accompanied with smog vascular network. The condition of moyamoya disease was significantly related to thyroid function, and moyamoya disease occurred in hyperthyroidism. Thyroid function improved and stroke improved. Antihyperthyroidism therapy can reduce brain metabolism, combined with nervous system therapy to improve symptoms. Superficial temporal artery fusion can increase blood compensation. Vascular reconstruction may be an effective method to prevent cerebral apoplexy. Conclusion: Graves's disease is related to the pathogenesis of moyamoya disease, the former directly affects the change of moyamoya disease, and the sudden change of thyroxine level in body can cause cerebral ischemic stroke, control hyperthyroidism and improve the symptoms of moyamoya disease. For young patients with basal cerebral artery occlusion, it is necessary to test thyroid function with or without hyperthyroidism and to perform MRA or DSA to facilitate early diagnosis.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R581.1;R743

【参考文献】