经DSA分析1000例缺血性脑血管病华人患者的病因特点

Analysis of the etiologic factors in 1 000 Chinese patients with ischemia cerebrovascular disease by DSA

目的探讨华人缺血性脑血管病的病因特点。方法回顾性分析经TCD、B超筛选过的1000例华人缺血性脑血管病患者的DSA资料,诊断为动脉粥样硬化性动脉狭窄和闭塞的患者737例,将其分为脑梗死组471例和短暂性脑缺血发作(TIA)组266例,分别对患者脑动脉狭窄及闭塞情况进行分析。结果1000例患者中,871例有与症状相关的颅内外脑血管病变。其中明确为动脉粥样硬化性动脉狭窄和闭塞的737例中,颅内病变367例,占49.8%;颅外病变245例,占33.2%;颅内外联合病变125例,占17.0%。脑梗死患者中颅内病变多于颅外病变(P=0.02),在椎基底动脉系统中表现尤为明显(P=0.002);而TIA患者颅内外病变发生率差异无显著性,但颈动脉系统仍以颅内病变为主(P=0.04),而椎基底动脉系统则主要以颅外动脉病变为主(P=0.02),狭窄部位依次为颈内动脉起始部(25.7%)、大脑中动脉(18.7%)、椎动脉起始部(15.9%)。结论在华人缺血性脑血管病患者中,颅内动脉病变发生率高于颅外动脉,但在TIA患者中,椎基底动脉病变仍以颅外病变为主。

Objective To investigate the characteristics of etiologic factors in Chinese patients with ischemie eerebrovascular disease Methods The DSA of 1 000 Chinese patients with ischemic cerebrovascular disease selected by TCI） and nhrasonography were reviewed. The patients were divided into cerebral infaretion group and TIA group, and the occurrence of cerebral arterial stenosis or occlusion were analyzed Results The DSA resnhs were positive in 871 cases. Alnong the 737 cases who were diagnosed as atherosclerotie eerehral arterial stenosis or occlusion. 367 cases （49.8%） had iatracranial arterial stenosis, 245 cases （33.2%） had extraeranial arterial stenosis and 125 cases （ 17% ） had both intra-and extracranial arterial stenosis. In the cerebral infaretion group, the occurrence of intraeranial artery stenosis was more frequent than that of extraerauial artery （ P = 0. 02 ） . especially in cases of posterior circulation cerebral infarction （P = 0. 002）. On the other hand, there was no statistic difference in TIA group, but the rfequency of intraeranial artery stenosis was still more higher than that of extracranial artery （P = 0. 04） in anterior circulation TIA. and the situation was opposite （P = 0. 02 ） in posterior circulalion TIA. The stenosis were found at the origin of ICA （25.7%） . MCA （ 18.7% ） and the origin of VA （ 15.9% ） respeetively. Conclusion The occurrence of intracranial arterial stenosis is more frequent than thai of extraeranial artery in Chinese patients with isehemia eerebrovascular disease except in cases of posterior circulation TIA.