大脑中动脉狭窄的侧支循环及其影响因素

The collateral circulation and the influential factors in patients with severe stenosis or occlusion of middle cerebral artery

目的探讨大脑中动脉(MCA)狭窄程度与侧支循环代偿建立的频率及类型关系;分析影响大脑中动脉侧支循环代偿建立的因素。方法回顾性分析78例MCA狭窄患者的临床资料,比较狭窄程度与侧支循环建立的关系,并比较有侧支循环组和无侧支循环组卒中的危险因素(高血压、高血脂、糖尿病)之间的差异。结果MCA不同的狭窄程度与有无侧支循环存在非常显著性差异(P=0.002);不同的狭窄程度其侧支循环代偿类型存在显著性差异(P=0.024)。糖尿病在有无侧支循环两组之间有差别(P=0.009);对侧支循环是否建立有影响的自变量有狭窄度(OR=4.147,P=0.003)和血脂(OR=7.526,P=0.015)。结论大脑中动脉狭窄程度越重,侧支开放出现的频率和级别越高;糖尿病不利于MCA狭窄后二级侧支循环的建立;MCA狭窄程度越重及高血脂可促进二级侧支循环的建立。高血压与侧支循环建立无明显相关。

Objective To explore the relationship between the degree of middle cerebral artery stenosis and the frequency and type of collateral circulation compensatory;then to analyse the factors that influenced the set up of collateral circulation of middle cerebral artery. Methods The clinical data of 78 cases of patients with MCA stenosis were retrospective analyzed. Results There was significant difference between the different degree of MCA stenosis and availability of collateral circulation（P=0.002）. There also was a significant difference between the different degree of stenosis and its collateral circulation type（P=0.024）. Comparing the difference of stroke risk factors（hypertension,hyperlipidemia,diabetes）between the groups with and without collateral circulation,we found that only the difference of collateral circulation between patients with diabetes and patients without diabetes showed significance（P=0.009）. The independent variables impacting the establishment of collateral circulation were degree of stenosis（OR=4.147,P=0.003）and lipids（OR=7.526,P=0.015）. Conclusion The higher degree of middle cerebral artery stenosis,the higher the frequency of collateral circulation compensatory and the higher level of the collateral circulation opening up. Diabetes is not conducive to the seting up of the secondary collateral circulation after middle cerebral artery stenosis. Hyperlipidemia and the degree of MCA stenosis play a promotive role for the establishment of the secondary collateral circulation. There is no significant relationship between hypertention and the seting up of collateral circulation.