烟雾病212例临床分析

发布时间：2019-05-18 17:44

【摘要】：烟雾病（moyamoya disease），又称脑底异常血管网病，是以脑血管造影发现双侧颈内动脉(internal carotid artery，ICA)虹吸部及大脑前、中动脉起始部严重狭窄或闭塞，颅底软脑膜、穿通动脉等小血管代偿增生形成脑底异常血管网为特征的一种慢性脑血管闭塞性疾病。明确的烟雾病病因尚不清楚。各国发病率、发病类型、发病年龄各具特点。数字减影血管造影(digital subtraction angiography, DSA)为诊断本病的金标准，核磁共振成像(magnatic resonance imaging, MRI)、磁共振血管成像(magnetic resonance angiography,MRA)、计算机断层扫描血管造影术(computed tomography angiography, CTA)等均对本病的诊断有较高的敏感性和特异性。依据不同患者的患病特点，采取适宜的内外科治疗。方法：对2009年1月~2013年12月入住我院的212例烟雾病患者进行回顾性调查研究。回顾性调查与其有关的临床资料，包括入院时间、年龄、性别、民族、发病类型、查体、既往病史、家族史、危险因素、实验室及超声影像学检查、治疗、出院时情况等。本研究使用SPSS17.0统计软件对本研究数据进行分析，计数资料采用χ2检验，p值根据情况取0.05或0.001。结果：1、按照联合国卫生组织（world health organization, WHO）年龄划分，儿童患者5.7%，青年患者35.4%，中老年患者59.0%。中老年患者例数明显高于儿童及青年患者例数。患者45~60岁例数多而集中。2、男性患者49.5%，，女性患者50.5%。男女比例接近1:1，患者总体性别比例无明显差异。儿童患者组，男性41.7%，女性58.3%；青年患者组，男性45.3%，女性54.7%；中老年患者组，男性52.8%，女性47.2%。儿童组、青年组和中老年组患者性别差异无显著性。3、高血压病病史25.5%，接种史89.6%，吸烟史35.8%，饮酒史22.6%，吸烟史同时有饮酒史17.9%。综上，患者高血压病病史、接种史、吸烟史、饮酒史均是发病的可疑危险因素。4、儿童患者组，缺血型58.3%，出血型41.7%；青年患者组，缺血型44.0%，出血型56.0%；中老年患者组，缺血型40.0%，出血型60.0%。按照年龄分组，三组内两种发病类型比例进行组间比较，儿童组、青年组和中老年组患者发病类型差异无显著性。按照发病类型分组，缺血型、出血型在不同年龄段的比例比较，缺血型、出血型患者在儿童、青年和中老年患者中分布差异无显著性。5、实验室检查，肝功异常者76.7%，外科综合异常者7.0%，外科综合及肝功均异常者16.4%。6、作为初次筛选的影像学检查，计算机断层扫描(computed tomography, CT)45.8%、CT联合CTA与CT联合经颅多普勒(transcranial doppler, TCD)共12.7%、MRA与MRA联合TCD共11.8%，TCD联合颈彩2.8%。以上数据可知，CT、CT联合CTA、CT联合TCD、MRA、MRA联合TCD，作为初次筛选检查在临床中应用多，TCD、颈彩已经开始应用于临床筛查。7、作为确诊的影像学检查，CTA28.3%、DSA40.6%、DSA联合CTA14.6%。以上数据可知，CTA、DSA、DSA联合CTA，作为确诊检查在临床中应用多，CTA诊断烟雾病比例显著高于其他检查（除DSA外）。8、内科治疗患者84.4%，外科治疗患者15.6%，患者以内科治疗为主。9、内科治疗缓解84.9%，未缓解15.1%；外科治疗缓解87.9%，未缓解12.1%。总缓解85.4%。本组研究表明，外科治疗缓解率较高。内科治疗、外科治疗效果统计学上差异无显著性。10、儿童患者共12例，缺血型7例，出血型5例。缺血型内科治疗7例，均缓解。出血型内科治疗3例，1例缓解，占33.3%，2例未缓解，占66.7%；外科治疗2例，均缓解。本研究提示儿童缺血型患者内科治疗效果显著，儿童出血型患者外科治疗效果显著。11、青年患者共75例，缺血型33例，出血型42例。缺血型内科治疗32例，均缓解；外科治疗1例，缓解。出血型内科治疗42例，31例缓解，占73.8%，11例未缓解，占26.2%；外科治疗0例。本研究提示青年缺血型患者内科治疗效果显著，青年出血型患者内科治疗有一定风险。12、中老年患者共125例，缺血型50例，出血型75例。缺血型内科治疗41例，37例缓解，占90.2%，4例未缓解，占9.8%；外科治疗9例，均缓解。本研究提示中老年缺血型患者内科、外科治疗均有显著效果。出血型内科治疗54例，44例缓解，占81.5%，10例未缓解，占18.5%；外科治疗21例，17例缓解，占81.0%，4例未缓解，占19.0%。经统计学分析，中老年出血型患者内科、外科治疗效果差异无显著性。本研究提示中老年出血型患者内科、外科治疗均有一定风险。13、儿童，间接手术1人，直接联合间接手术1人。青年，直接+间接手术1人。中老年：间接手术14人，直接+间接手术3人，动脉瘤夹闭+间接手术7人，动脉瘤栓塞/夹闭6人。间接手术占45.4%，直接+间接手术占15.2%，动脉瘤夹闭+间接手术21.2%，动脉瘤栓塞/夹闭18.2%。本组研究表明，间接搭桥术、联合手术临床应用多。结论：1、烟雾病好发于45~60岁，无显著的性别差异。2、高血压病病史、接种史、吸烟史、饮酒史是烟雾病的可疑危险因素。3、缺血型烟雾病、出血型烟雾病在不同年龄中无显著性的分布差异。4、CT、CT联合CTA、CT联合TCD、MRA、MRA联合TCD，作为初次筛选检查在临床中应用多，TCD、颈彩已经开始应用于临床筛查。5、CTA诊断烟雾病特异性强。6、烟雾病目前仍以内科治疗为主。内科治疗、外科治疗效果差异无显著性。内科治疗、外科治疗均有显著缓解率。间接搭桥术及联合手术可以应用于各个年龄烟雾病患者。
[Abstract]:Moyamoya disease, also known as the abnormal vessel network of the head of the brain, is one of the two-sided internal carotid artery (ICA) siphonage part and the anterior part of the brain, and the starting part of the central artery is very narrow or occluded, the base of the skull base is soft, A chronic cerebral vascular occlusive disease characterized by small blood vessel decompensation such as through-artery and the like. The clear cause of the smoke is not clear. The incidence, the type of the disease and the age of the disease are all the characteristics. Digital subtraction angiography (DSA) is a gold standard for diagnosis of this disease. Magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), computed tomography, CTA and the like have high sensitivity and specificity to the diagnosis of this disease. Appropriate internal surgical treatment is taken according to the disease characteristics of different patients. Methods: A retrospective study of 212 patients with smoke from January 2009 to December 2013 was carried out. A retrospective study of the clinical data related to it, including the time of admission, age, sex, ethnicity, type of onset, body, past medical history, family history, risk factors, laboratory and ultrasound imaging, treatment, and discharge The study data is analyzed using the SPSS17.0 statistical software, and the count data is verified by the Sup2. The p-value is 0.05 or 0.00 according to the case. 1. Results:1. According to the age division of the world health organization (WHO), 5.7% of the children, 35.4% of the youth, and 59 of the middle-aged and the elderly .0%. The number of middle-aged and old-aged patients is significantly higher than that of children and young people the number of patients. The number of patients with 45 to 60 years is more and more concentrated.2. 49.5% of the male patients,50 in the female .5%. The ratio of male to female is close to 1:1, and the overall sex ratio of the patient is not clear. Significant difference. Children's group, male 41.7%, female 58.3%; youth group, male 45.3%, female 54.7%; middle-aged and old-age group, male 52.8%, female 47 2%. There was no significant difference in the gender difference between the children's group, the young group and the middle-and-old-age group.3. The history of hypertension was 25.5%, the history of inoculation was 89.6%, the history of smoking was 35.8%, the history of drinking was 22.6%, and the history of smoking was 17. 9%. The history of hypertension, the history of vaccination, the history of smoking, and the history of drinking were the suspect risk factors of the disease.4. The group of children, 58.3% of the ischemic type, 41.7% of the blood group, 44.0% of the youth group, 44.0% of the ischemic type, 56.0% of the blood group, and 40 in the middle-aged and the elderly. .0%, blood type 60 .0%. According to the age group, there were no differences in the type of incidence among the three groups, and there was no difference in the type of the patients in the children's group, the young group and the middle-and-old-age group. There was no significant difference in the distribution of blood group among children, young people and middle-aged and old-aged and middle-aged and middle-aged and middle-aged and middle-aged patients. The CT combined with the CT and the CT combined with the transcranial Doppler (TCD) was 12.7%, the combination of the MRA and the MRA was 11.8% and the TCD combined with the neck-color 2. 8%. The above data shows that CT, CT, CTA, CT, TCD, MRA and MRA are combined with TCD. As a primary screening test, TCD and MRA have been applied to clinical screening.7. As a confirmed image, CTA2.8.3%, DSA40.6%, DSA and CTA14 It was found that CTA, DSA and DSA combined with CTA in the clinical application of CTA, DSA and DSA. The proportion of CTA in the diagnosis of smoke was significantly higher than that of other examinations (except for DSA).8. The patients with internal medicine were 84.4% and 15.6% of the patients with surgical treatment, and the patients were treated with internal medicine. The main.9, the medical treatment was relieved by 84.9%, with no relief of 15.1%; the surgical treatment was relieved by 87.9%, and the result was not relieved .1%. Total Response 85 .4%. The results of this study show that the surgical treatment is relieved The rate was high. There was no significant difference in the treatment of internal medicine and the effect of surgical treatment. There were 12 cases of children,7 cases of ischemic type, and hemorrhage. 5 cases of ischemic type,7 cases of ischemic internal medicine, All of them were relieved.3 cases were treated with blood group internal medicine,1 case was alleviated, 33.3% and 2 cases were not relieved, accounting for 66.7%, and the surgical treatment was 2 cases. The results showed that the treatment effect of the internal medicine of the children with ischemic type was remarkable, the surgical treatment effect of the children with blood group was remarkable.11,75 cases of the young patients,33 cases of the ischemic type, and the blood type 42 cases:32 cases of ischemic internal medicine and 1 case of surgical treatment In the treatment of 42 cases of blood group internal medicine,31 cases were relieved, 73.8% and 11 cases were not relieved, accounting for 26.2%, and the surgical treatment The results of this study indicated that the treatment effect of the internal medicine of the young ischemic type was significant, and there was a certain risk in the treatment of the patients with blood group. Of the 75 cases,41 cases were treated with ischemic internal medicine,37 cases were alleviated, 90.2% and 4 cases were not relieved, accounting for 9.8%, and the surgical treatment was 9 cases. The study indicated that the internal medicine and surgical treatment of the middle-and-old-aged and middle-aged and old-aged patients had significant effects. The results showed that 54 cases of blood group internal medicine were treated,44 cases were relieved, 81.5% and 10 cases were not relieved, accounting for 18.5%, the surgical treatment was 21 cases,17 cases were relieved, 81.0% and 4 cases were not relieved, accounting for 19%. In that middle-and-old-aged and old-age group, there was no difference in the effect of surgical treatment. The results showed that the internal medicine and surgical treatment of the middle-and-old-aged and old-aged patients had a certain risk.13. The indirect operation of the children and the indirect operation was directly combined with the indirect hand. 1 person. Young, direct + indirect. 1 person in the middle and old age:14 indirect operation,3 direct + indirect operation,7 aneurysm clipping + indirect operation, and aneurysm embolization/ clamp Closed 6 persons, indirect operation 45.4%, direct + indirect operation 15.2%, aneurysm clipping + indirect operation 21.2%, aneurysm embolization/ clipping 18 2%. The results of this study show that the indirect bridge operation and the combined operation are clinical. Conclusion:1. There is no significant difference in sex difference between 45 and 60 years. The history of hypertension, the history of inoculation, the history of smoking, and the history of alcohol consumption are the suspect risk factors of the smoke.3. There is no significant difference in the distribution of blood type and smoke in different ages. .4, CT, CT, CTA, CT, TCD, MRA and MRA combined with TCD. As a primary screening test, TCD and MRA were used in clinical screening. The treatment of medical treatment and surgical treatment is poor. There is no significant difference in medical treatment and surgical treatment. Significant remission rates. Indirect bridging and joint procedures can be applied to all ages
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

【共引文献】