高同型半胱氨酸血症患者脑血管造影23例分析

Characteristics of Cerebral Arteries in Patients with Hyperhomocysteinaemia

目的:探讨高同型半胱氨酸血症(hHcy)患者病变脑动脉的分布特征。方法:主动脉弓+全脑血管造影检查hHcy患者23例,分析不光滑及狭窄脑动脉的分布规律;并将单纯hHcy患者6例分为半胱氨酸组,Hcy增高同时合并原发性高血压和高脂血症患者7例分为合并组,比较2组年龄、血清Hcy水平、不光滑及狭窄血管数的差异。结果:23例患者均存在脑动脉不光滑病变(100%);动脉狭窄检出率颅外为47.82%,颅内为52.17%;颅外动脉发生狭窄的好发部位依次为:颈内动脉颅外段(19.57%),椎动脉颅外段(15.22%),无名动脉(8.70%);颅内动脉发生狭窄的好发部位依次为:颈内动脉颅内段(10.87%),椎动脉颅内段(10.87%),大脑中动脉M1段(8.70%);半胱氨酸组及合并组患者年龄、血清Hcy水平、不光滑及狭窄血管数差异均无统计学意义。结论:hHcy患者颅内、外动脉不光滑及狭窄病变的检出率相似,高血压、高血脂与hHcy对脑动脉的损伤无叠加效应。

Objective： To investigate the distribution of the roughness or stenosis occurred in the cerebral arteries in patients with hyperhomocysteinaemia（hHcy）.Methods： Twenty-three patients with hHcy were recruited for this study and digital subtraction angiogram（DSA） was used to inspect the cerebral arteries.The distribution of roughness or stenosis in the studied cerebral arteries was analyzed.Patients（n=6） with only hHcy were assigned to group A and patients with hypertension,hyperlipemia and hHcy（n=7） were assigned to group B.The ages,levels of Hcy and numbers of cerebral arteries with roughness or stenosis between two groups were compared.Results： Morphological changes of roughness have been observed in the cerebral arteries in all the patients（100%）.Stenosis was detected in 47.82% intracranial arteries and 52.17% extracranial arteries.The most common sites of stenosis in the intracranial arteries were extra-calvarium segment of the carotid arteries（19.57%）,extra-calvarium segment of the vertebral arteries（15.22%） and the innominate arteries（8.70%）.The common sites of stenosis in the extracranial arteries were intracalvarium segment of the carotid arteries（10.87%）,intracalvarium segment of vertebral arteries（10.87%） and middle cerebral arteries（8.70%）.The difference of ages,levels of Hcy and numbers of cerebral arteries with roughness or stenosis between the two groups was not statistically significant.Conclusion： The roughness and stenosis are similarly distributed in both the intracranial and extracranial arteries.Hypertension and hyperlipemia have not shown dramatic effect on the arteriocerebral formation in patients with hHcy.