缺血性脑血管病DSA分析

Evaluation of ischemic crebrovascular disease with digital subtraction angiography

目的探讨缺血性脑血管病患者脑动脉狭窄或闭塞的分布特征及危险因素。方法回顾性分析2006年6月至2010年12月收治的495例缺血性脑血管病患者的DSA资料.按年龄大小分为青中年组(28～59岁)和老年组(≥60岁)。所有患者均经CTA或MRA检查证实为脑动脉狭窄或闭塞,最后经DSA检查验证。结果 495例缺血性脑血管病患者中,452例经DSA检查确诊为动脉粥样硬化性狭窄或闭塞,其中35.2%(159例)为颅内动脉病变,31.8%(144例)为颅外动脉病变,33.0%(149例)为颅内、外病变并存;颅内动脉病变的发生率为68.1%(308例),稍高于颅外动脉的64.8%(293例)。青中年组单纯颅内动脉病变的比例明显高于老年组(95比64,P<0.01);老年组颅外动脉病变的发生率明显高于青中年组(80比64,P<0.01),后循环病变的发生率亦高于青中年组(155比112,P<0.05)。高血压、高龄、糖尿病是颅外动脉病变的独立危险因素,高血压、糖尿病是颅内动脉病变的独立危险因素。颅外病变组高龄患者的比例高于颅内病变组(P<0.05)。结论在缺血性脑血管病患者中,颅内动脉粥样硬化性病变的发生率高于颅外段,随着年龄的增长,单纯颅内动脉病变逐渐减少,颅外病变及后循环病变增多。颅外病变组高龄者多于颅内病变组。

Objective To analyze the distribution characteristics of cerebral arterial stenosis and occlusion in ischemic cerebrovascular diseases, and to discuss the risk factors influencing the cerebrovascular diseases. Methods During the period from June 2006 to Dec. 2010, a total of 495 patients with ischemic cerebrovascular diseases were admitted to authors hospital. The clinical data and DSA materials were retrospectively analyzed. According to the age, the patients were divided into young and middle-aged group （28 - 59 years） and old-aged group （≥ 60 years）. The diagnoses （cerebral arterial stenosis or occlusion） were confirmed by CTA or MRA in all patients, and were again checked with DSA. Results Of 495 cases, 452 were proved by DSA to be cerebral atherosclerotic artery stenosis or occlusion. Among the 452 patients, intracranial artery disease （IAD） was seen in 159 （35.2%）, extracranial artery disease （EADi in 144 （31.8%） and coexisting intracranial and extracranial artery disease in 149 （33.0%）. The incidence rate of IAD was 68.1% （n = 308）, which was slightly higher than that of EAD （64.8%, n = 293）. The proportion of pure IAD in the young middle-aged group was significantly higher than that in the old-aged group （95 vs 64, P 〈 0.01 ）, while the proportions of pure EAD and the posterior circulation disease in the old-aged group were significantly higher than those in the young and middle-aged group （80 vs 64,P 〈 0.01 and 155 vs 112,P 〈 0.05, respectively）. Muhivariable logistic regression analysis indicated that hypertension, the aged and diabetes were the independent risk factors for EAD, while hypertension and diabetes were the independent risk factors for IAD. The proportion of elderly patients in EAD group was higher than that in IAD group （P 〈 0.05）. Conclusion In patients with ischemic cerebrovascular diseases the incidence rate of intracranial artery atherosclerosis is higher than that of extracranial artery atherosclerosis. Along with the aging, the proportion of pure IAD gradually decreases while the incidence rate of EAD and posterior circulation disease increases. The aged patients in EAD group are much more than the aged ones in IAD group.（J Intervent Radiol, 2012, 21： 451-455）