烟雾病患者皮质微血管密度与脑硬膜颞浅动脉血管融通术疗效的关系

Cerebral cortical microvascular characteristics and the treatment outcome of encephalo-duro-arterio-synangiosis for patients with moyamoya disease

目的探讨烟雾病患者的皮质微血管特征与脑硬脑膜颞浅动脉血管融通术(EDAS)治疗效果间的关系。方法对77例资料完整的烟雾病患者进行回顾性分析。其中缺血型病例58例,出血型病例19例。77例患者均接受单侧或双侧EDAS,术中采集皮质血管照片,确定皮质微血管密度;术后随访患者临床症状的改善情况,并采用正电子发射断层显像(PET)评价脑代谢改善的程度,DSA评价术后血管重建情况。比较不同微血管密度与临床症状、脑代谢改善程度以及血管重建情况的关系。结果①77例患者术后临床症状改善优良率为66.2%,双侧均随微血管密度的增加,临床症状改善的优良率也增加,其中左侧χ2=2.708,P>0.05,右侧χ2=6.390,P<0.05。Spearman秩相关检验显示,左侧rS=-0.398,P<0.01,密度高者临床改善程度良好。②术后脑代谢评估,优良率为60.4%,脑代谢改善程度随微血管密度增加而上升,χ2=5.493,P略大于0.05;左侧比较中,χ2=7.233,P<0.05。Spearman秩相关检验显示,全组rS=-0.275,P<0.05;其中左侧rS=-0.388,P<0.01。③术后血管重建评估中,≥Ⅱ级为70.5%,不同微血管密度组比较,差异有统计学意义,χ2=30.252,P<0.01;微血管密度越高,≥Ⅱ级的血管重建的比例就越高。Spearman秩相关检验显示r,S=0.563,P<0.01。结论 EDAS术治疗烟雾病患者能够改善脑缺血症状和神经功能缺损程度,增加脑代谢和灌注。皮质微血管密度与EDAS治疗效果间存在等级相关关系。

Objective To investigate the relationship between the cerebral cortical microvascular characteristics and the treatment outcome of encephalo-duro-arterio-synangiosis （EDAS） in patients with moyamoya disease. Methods Seventy-seven patients with moyamoya disease （58 ischemic cases, 19 hemorrhagic cases） with complete data were analyzed retrospectively. All the 77 patients underwent unilateral or bilateral EDAS. The cortical angiograms were collected during the operation. The improvement of the postoperative clinical symptoms was followed up. The improvement of cerebral metabolism was evaluated by positron emission tomography （PET）, and the postoperative revascularization was evaluated by digital substraction angiography （DSA）. The relationship between different cortical microvascular densities and clinical symptoms, cerebral metabolism improvement and vascular reconstruction were compared. Results ①The rate of the clinical symptom improvement was 66. 2% in 77 patients. With the increased cortical microvascular density on both sides, the rate of the clinical symptom improvement was also increased （left hemisphere X2 = 2. 708, P 〉 0. 05, fight hemisphere X2 = 6. 390, P 〈 0. 05）. The Spearman rank correlation test showed that the left hemisphere was rs = -0. 398 （P 〈0. 01 ）. The patients with high cortical microvascular density had a good clinical improvement. ②The good rate reached 60. 4% in the postoperative assessment of cerebral metabolism. The cerebral metabolism improvement increased with the increased cortical microvascular density （X^2 = 5. 493, P 〉 0. 05） ; in comparison with the left hemisphere it was X^2 = 7. 233 （ P 〈 0.05 ）. The Spearman rank correlation test showed that the whole group was rs = - 0. 275 （ P 〈 0.05 ） , in which the left hemisphere was rs = - 0. 388 （P 〈 0.01 ）. ③In the postoperative revascularization assessment, the patients who reached grade t〉 2 was 70.5%. Compared to the different cortical rnicrovascular density groups, there were statistically significant differences 0（2 = 30. 252, P 〈 0. 01 ） ; The higher the cortical mierovascular density, the higher the proportion of grade ≥ 2 revascalarization. The Spearman rank correlation test showed that it was rs = 0. 563 （P 〈 0. 01 ）. Conclusion EDAS for treatment of patients with moyamoya disease can improve the symptoms of cerebral ischemia and neurological deficit, and increase in brain metabolism and cerebral perfusion. There is a grade correlation between the cortical microvascalar density and the treatment outcome of EDAS.