512例缺血性脑血管病患者DSA检查结果分析

Analysis of DSA in 512 cases of ischemic cerebrovascular disease

目的探讨缺血性脑血管病患者脑动脉狭窄或闭塞的分布特征,为临床治疗和预防提供依据。方法回顾性分析2009年11月至2013年6月我科收治的512例缺血性脑血管病患者数字减影血管造影(DSA)资料,按年龄大小分为青中年组和老年组,分析脑动脉狭窄随年龄变化的分布规律。结果①512例缺血性脑血管病中,检出349例(68.16%)存在血管狭窄或闭塞,病变血管736支,其中单支血管受累163例,多支血管受累186例。颅外血管病变135例(38.68%),颅内血管病变154例(44.13%),颅内外血管病变并存60例(17.19%)。颅内血管发病率稍高于颅外血管病变。②前循环血管受累156例(44.69%),后循环血管受累51例(14.61%),前后循环血管并存受累142例(40.70%)。③中青年组单纯颅内血管病变比例高于老年组(P<0.05);老年组后循环血管病变比例高于中青年组(P<0.01)。④脑血管病常见危险因素中,高血压、高血脂、糖尿病、高同型半胱氨酸,在颅内、颅外、颅内外血管病变并存中比较差异无统计学意义(P>0.05);高龄在颅内动脉病变的比例明显低于颅外及颅内外动脉病变并存的比例(P<0.01)。结论缺血性脑血管病患者中,动脉粥样硬化性血管狭窄或闭塞,颅内动脉段发生率高于颅外动脉段,随着年龄的增加,颅外动脉段及后循环发生率逐渐升高,总之,脑动脉狭窄的分布有年龄特征性。

Objective To analyze the distribution characteristics of cerebral arterial stenosis and occlusion in ischemic cerebrovascular diseases. Methods During November 2009 to June 2003,a total of 512 patients with ischemic cerebrovascular diseases were admitted to this hospital. The clinical data and DSA materials were retrospectively analyzed. According to the age,the patients were divided into young and middle- aged group and old- aged group. The characteristics of distribution of cerebral artery stenosis with age were analyzed. Results①Among the 512 cases of isthemic cerebrovascular stroke,intra- extracranial vascular stenosis was in 349 cases(68. 2%). As for incidence of single or dual stenosis among 736 vessels with adteriostensis,single stenosis amounted to 163 cases and dual to 186 cases. Extracranial artery disease was seen in 135(38. 68%),intracranial artery disease in 154(44. 13%),and coexisting intracranial and extracranial artery disease in 60(17. 19%). The incidence rate of intracranial artery disease was slightly higher than that of extracranial artery disease.②The cerebral infarction occurred in 156 cases(44. 69%) and was located in anterior circulation; 51 cases(14. 61%) in posterior circulation,and142 cases(40. 70%) in both anterior and posterior circulations. ③The proportion of pure intracranial artery disease in the young middle-aged group was significantly higher than that in the old- aged group( P < 0. 05). The posterior circulation diseases in the old- aged group were significantly higher than those in the young and middle- aged group( P < 0. 01).④Risk factors of high blood pressure,diabetes,dyslipidemia,hyperhomocystinemia in the intracranial,extracranial and intracranial lesions of the coexistence between patients with comparative differences had no statistical significance( P > 0. 05),in the age of cranial and intracranial arteries in proportion to the coexistence was obviously higher than intracranial arteries in the proportion( P < 0. 01). Conclusion The morbidity of intracranial arterial diseases is higher than that of extracranial artery diseases in ischemic cerebrovascular diseases,the distribution of cerebral artery disease varies with age,the proportion of extracranial artery diseases and co- existence of craniocervical artery diseases gradually increase with age and posterior circulation lesions gradually increase in the same way. In a word,the distribution of cerebral artery stenosis varies with age.