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中华脑血管病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 83 -87. doi: 10.11817/j.issn.1673-9248.2021.02.004

所属专题: 文献

论著

不稳定型烟雾病患者的临床特征及其发生的危险因素分析
赵黎明1, 梁浩1, 张韶1, 高涛1, 刘阳1, 孙玉学1, 郭高超1, 李天晓1, 栗超跃1,()   
  1. 1. 450003 郑州,河南省人民医院(郑州大学人民医院,河南大学人民医院)神经外科
  • 收稿日期:2020-07-28 出版日期:2021-04-01
  • 通信作者: 栗超跃

Study on clinical characteristics and risk factors of unstable moyamoya disease

Liming Zhao1, Hao Liang1, Shao Zhang1, Tao Gao1, Yang Liu1, Yuxue Sun1, Gaochao Guo1, Tianxiao Li1, Chaoyue Li1,()   

  1. 1. Department of Neurosurgery, Henan Provincial People's Hospital (Zhengzhou University People's Hospital, Henan University People's Hospital), Zhengzhou 450003, China
  • Received:2020-07-28 Published:2021-04-01
  • Corresponding author: Chaoyue Li
引用本文:

赵黎明, 梁浩, 张韶, 高涛, 刘阳, 孙玉学, 郭高超, 李天晓, 栗超跃. 不稳定型烟雾病患者的临床特征及其发生的危险因素分析[J/OL]. 中华脑血管病杂志(电子版), 2021, 15(02): 83-87.

Liming Zhao, Hao Liang, Shao Zhang, Tao Gao, Yang Liu, Yuxue Sun, Gaochao Guo, Tianxiao Li, Chaoyue Li. Study on clinical characteristics and risk factors of unstable moyamoya disease[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2021, 15(02): 83-87.

目的

对不稳定型烟雾病患者的临床特征和其发生的危险因素进行探讨。

方法

回顾性分析河南省人民医院烟雾病诊疗中心自2019年1月1日至2019年12月31日接受联合脑血流重建烟雾病患者261例的临床资料,比较稳定型组和不稳定型组的临床变量,总结不稳定型烟雾病临床特征,采用单因素和多因素Logistic回归分析归纳不稳定型烟雾病的危险因素。

结果

术前频繁短暂性脑缺血发作(TIA;OR=3.439,P=0.023)、收缩压(OR=1.097,P<0.001)是患者发生不稳定型烟雾病的危险因素。不稳定组术后新发卒中事件的发生率为42.31%(11/26),较稳定型烟雾病的3.40%(8/235),表现出了更高的术后再发卒中事件(χ2=39.133,P<0.001)。

结论

不稳定型烟雾病在影像学上具有颅内双侧血管的不对称性改变,患者更容易出现术前TIA频繁发作和更高的难控性血压。在行联合脑血流重建术后更易出现新发卒中事件。对此类患者,应加强围手术期评估管理、制定详实的手术方案、完备术后并发症的预防,对降低烟雾病手术治疗的病死率和致残率有深远影响。

Objective

To explore the clinical characteristics and risk factors of unstable moyamoya disease.

Methods

The clinical data of 261 patients with moyamoya disease, who received combined cerebral reconstruction in the Moyamoya Disease Center of Henan Provincial People's Hospital from January 1, 2019 to December 31, 2019, were analyzed retrospectively. The clinical variables of stable group and unstable group were compared, and the clinical characteristics of unstable moyamoya disease were summarized. Univariate and multivariate logistic regression analysis was used to summarize the risk factors of unstable moyamoya disease.

Results

The patients with unstable moyamoya disease showed higher frequency of preoperative TIA attacks (OR=3.439, P=0.023) and higher systolic blood pressure (OR=1.097, P<0.001). The incidence of new-onset postoperative stroke events in the unstable group was 42.31% (11/26), which was significantly higher than that of stable group (3.40%, 8/235; χ2=39.133, P<0.001).

Conclusion

Unstable moyamoya disease has asymmetrical changes of bilateral intracranial vessels on imaging, and such patients are more likely to present frequent preoperative TIA attacks and higher uncontrollable blood pressure. New-onset stroke events are more likely to occur after combined cerebral blood flow reconstruction. For this group of patients, we should strengthen the perioperative evaluation management, implement detailed surgical plans and postoperative management to prevent complications, which is fundamental to reduce the mortality and disability of surgical treatment of moyamoya disease.

图1 单侧狭窄、对侧闭塞患者脑血管造影检查。不稳定型烟雾病:左侧大脑中动脉重度狭窄,不伴有烟雾状血管形成(图a);右侧大脑前动脉闭塞,伴有烟雾血管形成(图b);稳定型烟雾病:右侧大脑前动脉和大脑中动脉闭塞,伴有烟雾血管形成(图c);左侧大脑中动脉重度狭窄,伴烟雾状血管形成(图d)
表1 稳定型和不稳定型烟雾病患者一般资料和临床特征单因素分析
表2 稳定型和不稳定型烟雾病患者一般资料和临床特征多因素分析
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