切换至 "中华医学电子期刊资源库"

中华脑血管病杂志(电子版) ›› 2026, Vol. 20 ›› Issue (04) : 462 -466. doi: 10.3877/cma.j.issn.1673-9248.2026.04.016

综述

烟雾病抗血小板治疗的研究进展
於原思渡1,2, 张鑫3, 郭熙朗1,2, 李北1,2, 罗亦弘1,2, 高丽1,(), 王刚1,()   
  1. 1 200127 上海交通大学医学院附属仁济医院神经内科
    2 200135 上海交通大学医学院
    3 200002 上海,复旦大学附属华山医院神经外科
  • 收稿日期:2026-02-26 出版日期:2026-08-01
  • 通信作者: 高丽, 王刚
  • 基金资助:
    国家自然科学基金项目(81801298); 上海交通大学“交大之星”医工交叉项目(YG2023QNB10); 上海交通大学医学院大学生创新训练计划(20260241)

Research advances in antiplatelet therapy for Moyamoya disease

Yuansidu Yu1,2, Xin Zhang3, Xilang Guo1,2, Bei Li1,2, Yihong Luo1,2, Li Gao1,(), Gang Wang1,()   

  1. 1 Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
    2 School of Medicine, Shanghai Jiao Tong University, Shanghai 200135, China
    3 Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200002, China
  • Received:2026-02-26 Published:2026-08-01
  • Corresponding author: Li Gao, Gang Wang
引用本文:

於原思渡, 张鑫, 郭熙朗, 李北, 罗亦弘, 高丽, 王刚. 烟雾病抗血小板治疗的研究进展[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 462-466.

Yuansidu Yu, Xin Zhang, Xilang Guo, Bei Li, Yihong Luo, Li Gao, Gang Wang. Research advances in antiplatelet therapy for Moyamoya disease[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2026, 20(04): 462-466.

烟雾病(MMD)是一种以颈内动脉末端及大脑中动脉起始部进行性狭窄、合并颅底代偿性异常血管网形成为病理特征的脑血管疾病,兼具缺血性与出血性脑卒中的双重风险,其临床治疗策略的制定极具挑战性。抗血小板疗法是缺血型MMD药物治疗的基石。然而,这一疗法对于MMD血流动力学的改善作用尚不明确,同时存在潜在的出血转化风险,因而在临床应用中存在一定的争议。抗血小板治疗对于MMD的脑卒中预防具有一定的潜在价值,但亚洲人群的临床数据却呈现出显著的异质性,尤其是对于影像学确诊的无症状MMD患者,抗血小板治疗的风险获益比仍未明确。本综述拟就抗血小板治疗在MMD中的病理生理学基础、临床应用现状、安全性争议及药物选择策略进行综述,以期为临床精准决策及后续前瞻性研究提供理论依据。

Moyamoya disease (MMD) is a cerebrovascular disorder characterized by progressive stenosis of the terminal portion of the internal carotid artery and proximal middle cerebral artery, along with the formation of abnormal compensatory collateral vessels at the base of the brain. It confers dual risks of both ischemic and hemorrhagic stroke, making the formulation of clinical treatment strategies highly challenging. Antiplatelet therapy serves as the cornerstone of medical treatment for ischemic MMD. However, its exact efficacy in improving cerebral hemodynamics remains unclear. Furthermore, due to the potential risk of hemorrhagic transformation, its clinical application remains controversial. Although antiplatelet therapy holds theoretical promise for secondary stroke prevention in MMD, findings from studies in Asian populations have been inconsistent, particularly regarding the benefits of primary stroke prevention after a radiological diagnosis of asymptomatic MMD. This review synthesizes current evidence on the pathophysiological basis, current clinical status, safety controversies, and pharmacological selection strategies of antiplatelet therapy for MMD. Its aim is to provide a theoretical foundation to guide precision clinical decision-making and inform the design of future.

1
尤寿江, 曹勇军, 章春园, 等. 成人烟雾病的临床特点、分期及代偿机制分析[J/OL]. 中华脑血管病杂志(电子版), 2011, 5(2): 89-95.
2
Ihara M, Yamamoto Y, Hattori Y, et al. Moyamoya disease: diagnosis and interventions[J]. Lancet Neurol, 2022, 21(8): 747-758.
3
Suzuki J, Takaku A. Cerebrovascular "Moyamoya" disease: disease showing abnormal net-like vessels in base of brain[J]. Arch Neurol, 1969, 20(3): 288-299.
4
Scott RM, Smith ER. Moyamoya disease and Moyamoya syndrome[J]. N Engl J Med, 2009, 360(12): 1226-1237.
5
中华医学会神经外科学分会. 烟雾病和烟雾综合征诊断与治疗中国专家共识(2024版)[J]. 中华神经外科杂志, 2024, 40(3): 220-229.
6
Kuroda S, Houkin K. Moyamoya disease: current concepts and future perspectives[J]. Lancet Neurol, 2008, 7(11): 1056-1066.
7
刘阳, 郭高超, 赵黎明, 等. 儿童烟雾病的临床特征、手术治疗及疗效分析[J/OL]. 中华脑血管病杂志(电子版), 2021, 15(4): 237-241.
8
Pang CH, Cho WS, Kang HS, et al. Benefits and risks of antiplatelet medication in hemodynamically stable adult Moyamoya disease[J]. Sci Rep, 2021, 11(1): 19367.
9
Lu J, Li Z, Zhao Y, et al. Hemorrhagic transformation in ischemic Moyamoya disease: clinical characteristics, radiological features, and outcomes[J]. Front Neurol, 2020, 11: 517.
10
Yan Y, Li Y, Huang L, et al. A comprehensive Meta-analysis for bypass surgery in adult Moyamoya[J]. World Neurosurg, 2019, 124: 161-170.
11
Bang OY, Fujimura M. Medical management of adult Moyamoya disease: a review and relevant cases with ischemic events[J]. J Stroke, 2025, 27(1): 1-18.
12
Fujimura M, Tominaga T, Kuroda S, et al. 2021 Japanese guidelines for the management of Moyamoya disease: guidelines from the Research Committee on Moyamoya disease and Japan Stroke Society[J]. Neurol Med Chir (Tokyo), 2022, 62(4): 165-170.
13
Liu H, Fukasawa T, Anno T, et al. Incidence, prevalence, and treatment of Moyamoya disease in Japan: a population-based descriptive study[J]. J Stroke Cerebrovasc Dis, 2024, 33(8): 107770.
14
Duan L, Bao XY, Yang WZ, et al. Moyamoya disease in China: its clinical features and outcomes[J]. Stroke, 2012, 43(1): 56-60.
15
高坤, 杨波, 李红伟, 等. 河南地区烟雾病临床特征及治疗分析[J]. 河南医学研究, 2018, 27(5): 788-792.
16
李治, 吕梁, 黄莹, 等. 回顾性分析云南地区烟雾病流行病学特点[J]. 世界最新医学信息文摘, 2019,19(94): 18-19, 21.
17
Oki K, Katsumata M, Izawa Y, et al. Trends of antiplatelet therapy for the management of Moyamoya disease in Japan: results of a nationwide survey[J]. J Stroke Cerebrovasc Dis, 2018, 27(12): 3605-3612.
18
Kraemer M, Berlit P, Diesner F, et al. What is the expert's option on antiplatelet therapy in Moyamoya disease? Results of a worldwide survey[J]. Eur J Neurol, 2012, 19(1): 163-167.
19
Shulman JG, Snider S, Vaitkevicius H, et al. Direct visualization of arterial emboli in Moyamoya syndrome[J]. Front Neurol, 2017, 8: 425.
20
Yamashita M, Oka K, Tanaka K. Cervico-cephalic arterial thrombi and thromboemboli in Moyamoya disease--possible correlation with progressive intimal thickening in the intracranial major arteries[J]. Stroke, 1984, 15(2): 264-270.
21
Kim DY, Son JP, Yeon JY, et al. Infarct pattern and collateral status in adult Moyamoya disease[J]. Stroke, 2017, 48(1): 111-116.
22
Chen J, Duan L, Xu W H, et al. Microembolic signals predict cerebral ischaemic events in patients with Moyamoya disease[J]. Eur J Neurol, 2014, 21(5): 785-790.
23
Pompsch M, Veltkamp R, Diehl RR, et al. Microembolic signals and antiplatelet therapy in Moyamoya angiopathy[J]. J Neurol, 2022, 269(12): 6605-6612.
24
Kuroda S, Hashimoto N, Yoshimoto T, et al. Radiological findings, clinical course, and outcome in asymptomatic Moyamoya disease[J]. Stroke, 2007, 38(5): 1430-1435.
25
Chen J, Hu YH, Gao S, et al. Accidental microembolic signals: prevalence and clinical relevance[J]. Neurovasc Imaging, 2016, 2(1): 5.
26
Kuroda S, Yamamoto S, Funaki T, et al. Five-Year stroke risk and its predictors in asymptomatic Moyamoya disease: Asymptomatic Moyamoya Registry (AMORE)[J]. Stroke, 2023, 54(6): 1494-1504.
27
Acker G, Lange C, Schatka I, et al. Brain perfusion imaging under acetazolamide challenge for detection of impaired cerebrovascular reserve capacity: positive findings with 15O-water PET in patients with negative 99mTc-HMPAO SPECT findings[J]. J Nucl Med, 2018, 59(2): 294-298.
28
Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack[J]. N Engl J Med, 2013, 369(1): 11-19.
29
Bersano A, Khan N, Fuentes B, et al. European Stroke Organisation (ESO) guidelines on Moyamoya angiopathy endorsed by Vascular European Reference Network (VASCERN)[J]. Eur Stroke J, 2023, 8(1): 55-84.
30
Seo WK, Kim JY, Choi EH, et al. Association of antiplatelet therapy, including cilostazol, with improved survival in patients with Moyamoya disease in a nationwide study[J]. J Am Heart Assoc, 2021, 10(5): e017701.
31
Luo Y, Cao Z, Ye H, et al. Antiplatelet therapy may improve the prognosis of patients with Moyamoya disease: a 12-year retrospective study[J]. J Neurol, 2023, 270(8): 3876-3884.
32
Onozuka D, Hagihara A, Nishimura K, et al. Prehospital antiplatelet use and functional status on admission of patients with non-haemorrhagic Moyamoya disease: a nationwide retrospective cohort study (J-ASPECT study)[J]. BMJ Open, 2016, 6(3): e009942.
33
Ye F, Li J, Wang T, et al. Efficacy and safety of antiplatelet agents for adult patients with ischemic Moyamoya disease[J]. Front Neurol, 2020, 11: 608000.
34
Chiba T, Setta K, Shimada Y, et al. Comparison of effects between clopidogrel and cilostazol on cerebral perfusion in nonsurgical adult patients with symptomatically ischemic Moyamoya disease: subanalysis of a prospective cohort[J]. J Stroke Cerebrovasc Dis, 2018, 27(11): 3373-3379.
35
Lu M, Zhang H, Liu S, et al. Effects of antiplatelet therapy on reducing stroke risk in patients with Moyamoya disease: the role of postcontrast MR vessel wall imaging[J]. Eur Radiol, 2025, 35(10): 5911-5921.
36
Liu T, Qin M, Xiong X, et al. Benefits and risks of antiplatelet therapy for Moyamoya disease: a systematic review and Meta-analysis[J]. Front Neurol, 2023, 14: 1132339.
37
Rashad S, Saqr KM, Fujimura M, et al. The hemodynamic complexities underlying transient ischemic attacks in early-stage Moyamoya disease: an exploratory CFD study[J]. Sci Rep, 2020, 10(1): 3700.
38
Yamada S, Oki K, Itoh Y, et al. Effects of surgery and antiplatelet therapy in ten-year follow-up from the registry study of research committee on Moyamoya disease in Japan[J]. J Stroke Cerebrovasc Dis, 2016, 25(2): 340-349.
39
Miyamoto S, Yoshimoto T, Hashimoto N, et al. Effects of extracranial-intracranial bypass for patients with hemorrhagic Moyamoya disease[J]. Stroke, 2014, 45(5): 1415-1421.
40
Haller S, Vernooij MW, Kuijer JPA, et al. Cerebral microbleeds: imaging and clinical significance[J]. Radiology, 2018, 287(1): 11-28.
41
Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis, Health Labour Sciences Research Grant for Research on Measures for Infractable Diseases. Guidelines for diagnosis and treatment of Moyamoya disease (spontaneous occlusion of the circle of Willis)[J]. Neurol Med Chir (Tokyo), 2012, 52(5): 245-266.
42
Bagyinszky E, Yang Y, An SSA. Multisystemic impact of RNF213 Arg4810Lys: a comprehensive review of Moyamoya disease and associated vasculopathies[J]. Int J Mol Sci, 2025, 26(16): 7864.
43
Soman T, Rafay MF, Hune S, et al. The risks and safety of clopidogrel in pediatric arterial ischemic stroke[J]. Stroke, 2006, 37(4): 1120-1122.
44
Aihara Y, Kashiwase S, Chiba K, et al. Aspirin use and platelet aggregation in ischemic onset-type pediatric Moyamoya patients with intractable headaches (moya-ache)[J]. Childs Nerv Syst, 2021, 37(5): 1649-1657.
45
Funaki T, Takahashi JC, Houkin K, et al. High rebleeding risk associated with choroidal collateral vessels in hemorrhagic Moyamoya disease: analysis of a nonsurgical cohort in the Japan adult Moyamoya trial[J]. J Neurosurg, 2019, 130(2): 525-530.
46
Yamashita M, Oka K, Tanaka K. Histopathology of the brain vascular network in Moyamoya disease[J]. Stroke, 1983, 14(1): 50-58.
47
Ryu J, Lee KM, Woo HG, et al. Morphologic differences between ruptured and unruptured choroidal anastomosis in adult Moyamoya disease: a high-resolution vessel wall imaging study[J]. J Neurosurg, 2024, 140(2): 441-449.
48
Xiang Y, Zhang P, Zhao P, et al. Effects of aspirin therapy on bypass efficacy and survival of patients receiving direct cerebral revascularization[J]. Front Pharmacol, 2022, 13: 841174.
49
Zhao Y, Zhang Q, Zhang D, et al. Effect of aspirin in postoperative management of adult ischemic Moyamoya disease[J]. World Neurosurg, 2017, 105: 728-731.
50
Abedi A, Sizdahkhani S, Choi W, et al. Cilostazol for the management of Moyamoya disease: a systematic review of the early evidence, efficacy, safety, and future directions[J]. Neurosurg Focus, 2023, 55(4): E9.
51
Michelson AD. Platelets[M]. 2nd ed. Burlington (Canada): Academic Press, 2007: 1181-1191.
52
Ando S, Tsutsui S, Miyoshi K, et al. Cilostazol may improve cognition better than clopidogrel in non-surgical adult patients with ischemic Moyamoya disease: subanalysis of a prospective cohort[J]. Neurol Res, 2019, 41(5): 480-487.
53
Shinohara Y, Katayama Y, Uchiyama S, et al. Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised non-inferiority trial[J]. Lancet Neurol, 2010, 9(10): 959-968.
54
Hartkamp NS, Hendrikse J, de Borst GJ, et al. Intracerebral steal phenomenon in symptomatic carotid artery disease[J]. J Neuroradiol, 2019, 46(3): 173-178.
[1] 郭慧, 孔琦, 程芸, 张思然. 经颅多普勒超声脑血流动力学参数对前循环小动脉闭塞型脑卒中短期预后的预测价值[J/OL]. 中华医学超声杂志(电子版), 2026, 23(03): 236-243.
[2] 李晓慧, 杭宇, 汪璇, 贾振宇, 茆丽娜, 代龙泉, 施海彬, 季荔. 阿替普酶静脉溶栓桥接机械取栓治疗急性前循环大血管闭塞性脑卒中后出血转化的危险因素分析[J/OL]. 中华介入放射学电子杂志, 2026, 14(03): 286-291.
[3] 李若曼, 王帆, 张涛. ASPECTS联合表观弥散系数对急性缺血性脑卒中静脉溶栓预后的预测价值[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 403-410.
[4] 张爽, 谢琦, 杨清武. 急性缺血性脑卒中无效再通的研究进展及脑保护新策略[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 351-358.
[5] 戴荣源, 裴月红, 孙庆利, 黄骁, 张淦, 樊东升, 傅瑜. 美国心脏协会/美国卒中协会《2026年急性缺血性脑卒中患者早期管理指南》更新概述[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 359-364.
[6] 曾陈颖, 陈云清, 徐祖兵, 余求龙, 林晶, 洪道俊, 涂琪. 炎症标志物在大梗死核心与非大梗死核心急性缺血性脑卒中行血管内治疗的预后价值[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 372-379.
[7] 魏宸铭, 牟婧宇, 赵心怡, 陈乐, 武剑. 不同评分量表对前循环大血管闭塞性脑卒中诊断预测性能的差异[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 380-388.
[8] 康志霞, 班玉霞, 白如玉, 郝美美, 李正正, 苏琴琴. 血浆致动脉硬化指数和程序性细胞死亡因子4预测急性缺血性脑卒中神经功能缺损及预后的价值[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 389-395.
[9] 胡琼丹, 侯善兵, 陈霞, 王教媛, 戴晓熹. 应激性血糖升高比值预测急性缺血性脑卒中静脉溶栓预后的价值[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 396-402.
[10] 张珊珊, 王萌, 陈春霞, 薛鑫鑫, 谭静静, 王侠. 基于COM-B模型脑心健康管理师主导的健康管理在脑卒中患者中的应用效果[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 418-425.
[11] 穆巴拉克·伊力哈木, 纪蒙, 秦伟, 胡文立, 王朝东, 鲁明. 基于两样本孟德尔随机化分析甲状腺功能与缺血性脑卒中的因果关系[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 432-439.
[12] 周英, 李文雯, 周钰, 李炜, 贺思怡, 夏海艳, 王海玲. 基于临床医护人员视角的急性缺血性脑卒中患者就医延迟成因与对策的质性研究[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 446-454.
[13] 黄开来, 李威, 赵振强. 依达拉奉右莰醇在急性缺血性脑卒中的临床应用进展[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(04): 455-461.
[14] 刘诗馨, 宋晓微, 武剑. 临床视角下人工智能赋能脑卒中康复的范式重塑[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(03): 231-239.
[15] 朱恩俊儒, 程畅, 贺玉琴, 姚笛, 郝嘉欢, 汪明欢. 缺血性脑卒中患者的肌肉健康与类淋巴系统相关性[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(03): 258-265.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?