血管压迫延髓腹外侧与原发性高血压相关性研究

Study on neurovascular compression of the rostral ventrolateral medulla related to essential hypertension

目的:评价原发性高血压与延髓腹外侧血管压迫的相关性。方法:2位有经验的影像诊断医师共同分析20例原发性高血压病人、10例继发性高血压病人、18例正常对照组的MRI。结果:第一组中15例(n=20,75%)、第二组中1例(n=10,10%)、第三组中2例(n=18,11%)延髓头侧腹外侧部(RVLM)受压(P<0.01)。所见责任血管15例原发性高血压小脑后下动脉(PICA)10例(67%),小脑前下动脉(AICA)2例(13%),椎动脉(VA)3例(20%)。另3例为PICA。15例原发性高血压中分别见7例左、右单侧受压,1例两侧同时受压;另3例均为右侧受压。第一组中橄榄后沟中心与最近动脉的距离平均为(1.1±3.0)mm,第二组为(4.9±4.0)mm,第三组为(3.8±2.2)mm(P<0.05)。延髓髓质表面与最近动脉的距离,第一组为(0.5±0.9)mm,第二组为(1.5±1.6)mm,第三组为(1.6±2.1)mm,三组间无显著性差异。结论:原发性高血压与血管压迫RVLM关系密切,而与延髓其它部位受压无关。

Objective： To prospectively evaluate neurovascular compression of the rostral ventrolateral medulla related to essential hypertension. Methods： Patients with essential hypertension（group 1; n=20）, secondary hypertension（group 2; n=10）, and normotensive subjects（group 3; n=18） underwent brain stem MR imaging and MR angiography. The images were interpreted consensually by two radiologists who were blinded to the patients＇ hypertensive status. Results： Neurovascular compression of the RVLM was observed in 15 of 20（75%） patients with essential hypertension; only 1 of the 10（10%） patients with secondary hypertension and only 2 of the 18（11%） normotensive subjects. The rate of neurovascular compression in the essential hypertension group was significantly higher than those in the other groups（P〈0.01 for both）. The distances between the RVLM and the nearest arteries in the essential hypertension group were significantly shorter than those in the other groups（P〈0.05 for all）. The distances between the surface of the medulla oblongata and the nearest arteries did not differ among these three groups. Conclusion： Neurovaseular compression of the RVLM, but not of the other regions of the medulla oblongata, is particularly related to essential hypertension.