儿童与成人烟雾病数字减影血管造影对比分析

A comparative analysis of the digital subtraction angiography of child and adult patients with moyamoya disease

目的 探讨儿童型和成人型烟雾病患者脑血管造影的特征及与临床表现的关系。方法 回顾性分析儿童及成人20例烟雾病患者的临床表现及数字减影血管造影（DSA）的影像特点。结果 成人颈内动脉（ICA）、大脑前动脉（ACA）、大脑中动脉（MCA）双侧对称受累较儿童显著多见（P〈0．01）；ICA以狭窄为主，ACA、MCA段闭塞明显增多，成人闭塞比例较儿童更高（P〈0．05）。儿童44．44％，成人72．73％脑底有大量烟雾状血管；大脑后动脉及其分支增粗者儿童77．78％，成人81．82％；颈外动脉向颈内动脉的代偿：儿童组44．44％，成人组36．36％。结论 儿童型和成人型烟雾病患者的DSA表现明显不同，儿童型颈内动脉病变较轻，侧支代偿较差，临床表现以缺血多见；成人型颈内动脉病变较严重，侧支代偿较好，临床表现以出血为主。基底部烟雾状血管的广泛发展、扭曲紊乱与脑出血密切相关。

Objective To explore the clinical features and digital subtraction angiography （DSA） manifestation in child and adult patients with moyamoya disease （MMD） and the relationship between them. Methods The clinical presentation and DSA manifestation of 20 patients with MMD were reviewed retrospectively. Results The incidence of symmetrically bilateral involvement of the internal carotid artery（ ICA）, anterior cerebral artery （ACA） and middle cerebral artery （MCA） in adult MMD was significantly higher than that in children MMD （ P 〈0. 01 ）. ICA often manifested stenosis, while ACA and MCA had more occlusive lesions especially in adults （ P 〈0. 05）. Extensive basal moyamoya vessels were found in 44.44% of the children and 72. 73% of the adults. Dilation and branch extension of the PCA were found in 77.78% of the children and 81.82% of the adults. Blood flow from external carotid artery （ECA）system to ICA system was noted in 44. 44% of the children and 36. 36% of the adults. Conclusion The DSA manifestation in the child group was significantly different from that in the adult group. Adult MMDs demonstrate severer occlusive arterial lesions and more abundant collateral circulation than that in children, and consequently the adults often manifested hemorrhage while the children had more ischemic lesions. There was a relationship between hemorrhage and the proliferation of basal moyamoya vessels.