合并Graves病的成人烟雾病疗效分析

Analysis of Curative Effect of Adult Moyamoya Disease Complicated with Graves Disease

目的探讨烟雾病合并Graves病(毒性弥漫性甲状腺肿)的临床特征、发病机制、手术及药物治疗的效果。方法回顾性分析4例成人烟雾病合Graves病患者的临床资料,所有患者均符合烟雾病及Graves病的诊断标准。3例患者在甲亢稳定1个月后,1例在甲状腺功能未完全正常时行直接间接联合血管重建术。结果 14例患者中,3例为女性,1例男性。平均年龄32.3岁(27-42岁)。24例患者中,3例表现为脑梗塞,1例表现为频发TIA。影像学DSA证实2例为单侧烟雾病,2例为双侧烟雾病;MR均可见脑梗塞灶。3对4例患者的随访时间为6-18个月,4患者经治疗后,神经功能症状均减轻或消失,无新发神经功能障碍。SPECT提示脑缺血灶较术前明显改善,CTA提示吻合口通畅。无手术并发症。结论烟雾病合并Graves病以女性患者为多,临床症状主要表现为脑缺血发作或脑梗死。控制甲亢症状后,行手术治疗能够建立有效的侧支循环,改善临床症状。手术时机须根据甲状腺功能及烟雾病症状宜早实施。

Objective To investigate the clinical features, operation and drug treatment effect of Moyamoya disease complicated with Graves disease （GD）. Methods A retrospective analysis was done to 4 patients＇ clinical data of adult Moyamoya disease complicated with Graves disease, all patients were diagnosed Moyamoya disease and Graves disease. Direct/indirect combined vascular reconstruction were performed in 4patients, 3 patients complicated with hyperthyroidism were stable for 1 months, 1 patient was not completely normal in thyroid function. Results①3 patients were female, 1 male cases of the 4 patients. The average age was 32.3 years （27-42 years）. ②Of the 4 patients, 3 cases showed cerebral infarction, 1 cases showed frequent TIA. Digital subtraction angiography confirmed 2 cases of unilateral moyamoya disease, 2 cases were bilateral moyamoya disease; magnetic resonance showed cerebral infarction. ③4 patients were followed up for 6-18 months, 4 patients were relieved or disappeared of neurological symptoms after treatment, no new neurological dysfunction appearred. SPECT showed the focal brain ischemia significantly improved compared with preoperative, CTA showed prompt anastomosis. No operation complication occurred. Conclusion Moyamoya disease complicated with Graves disease is more common in female, with cerebral infarction or cerebral ischemic attack as the main clinical symptoms.Surgical operation can establish effective collateral circulation and improve the clinical symptoms after the hyperthyroidism symptoms were controlled. Timing of operation should be implemented earlier according to the thyroid function and symptoms of moyamoya disease.