脑动脉狭窄分布特征及其危险因素的分析

Analysis of the distributive characteristics of cerebral arterial stenosis and its risk factors

目的探讨缺血性脑血管病患者的脑动脉狭窄病变的分布,以及与动脉粥样硬化危险因素的关系。方法回顾性分析377例经脑血管造影检查的脑缺血患者的临床资料,由两名神经科医师分别对血管狭窄病变的部位、程度进行统计,并按照病变发生的部位及程度,分为单纯颅内动脉病变组、单纯颅外动脉病变组、重度狭窄及闭塞组以及多发性血管病变组,对其动脉粥样硬化的危险因素进行分析。结果①377例患者中,存在脑血管病变的患者有285例,共检出病变数892处,其中颅外动脉病变438处(49.1%),颅内动脉病变454处(50.9%)。前者最常见于颈内动脉颅外段(19.6%,175/892),后者最常见于颈内动脉颅内段(15.0%,134/892)及大脑中动脉(12.4%,111/892)。②对血管狭窄程度的分析表明,颅外动脉中,以椎动脉及颈内动脉颅外段的狭窄程度最为严重,与颈总动脉比较,差异有统计学意义(P<0.05);颅内动脉则以大脑前动脉及大脑中动脉的狭窄程度严重。③单纯颅内动脉病变的患者合并有高血压病的比率较单纯颅外动脉病变者多(80.39%,59.42%),差异有统计学意义(P=0.015)。存在严重血管病变患者的多项动脉粥样硬化危险因素较造影正常的患者增多。结论缺血性脑血管病患者颅内动脉病变略多于颅外动脉。椎动脉及颈内动脉颅外段、大脑前动脉、大脑中动脉狭窄程度较为严重。单纯颅内动脉病变的患者合并有高血压病的比率较单纯颅外动脉病变者明显增高;动脉硬化危险因素增多,脑血管造影出现血管重度狭窄的概率增大。

Objective To investigate the distribution of cerebral artery stenosis in patients with ischemic eerebrovascular disease and its relationship with the risk factors for atheroselerosis. Methods Three hundred seventy-seven patients with ischemic cerebrovaseular disease detected by cerebral angiography were analyzed retrospectively. The location and degree of arterial stenosis were recorded by two neurologists respectively. The patients were divided into intracranial arterial lesion, extracranial arterial lesion, severe stenosis, occlusion and multiple vascular lesion groups according to the location and severity of the lesions. The risk factors for atherosclerosis were also analyzed. Results （1）Of the 377 patients, 285 had vascular lesions. A total of 892 lesions were detected. Of those, intracranial arterial lesions were 438 （49.1%） , intracranial arterial lesions were 454 （50.9%）. The former was most commonly observed in the extracranial internal carotid arteries （19.6%, 175/892）, and the latter was mostly seen in the extraeranial internal carotid arteries （ 15.0% , 134/892 ） and middle cerebral arteries （ 12.4% , 111/892 ）. （2）Among the extracranial arteries, the stenotic degree of vertebral artery and extracranial internal carotid artery were most severe. There were statistical significance as compared to the common carotid artery （ P 〈 0.05） ; while in the intraeranial arteries the stenotic degree of anterior cerebral artery and middle cerebral artery were most severe. （3）The proportion of patients with intraeranial arterial lesion alone complicating hypertension was higher than those with extracranial arterial lesion alone（ 80.39% vs. 59.42% ）. There were significant difference （ P = 0. 015 ）. The multiple risk factors for atherosclerosis in patients with server vascular lesion were higher than those in the angiographically normal patients. Conclusions The intracranial arterial lesion in patients with ischemic cerebrovascular disease was slightly more than that of extracranial artery. The stenotic degree in vertebral artery, extracranial internal carotid artery, anterior cerebral artery, and middle cerebral artery are more severe. The proportion of the patients with intracranial arterial lesion alone and complicating hypertension is significantly higher than that of the patients with extracranial arterial lesion alone. With the increase of the risk factors for arteriosclerosis, the probability of severe vascular stenosis will increase on cerebral angiography