Suzuki分级及异常代偿血管与成人烟雾病脑出血及缺血的关系

Relationship between Suzuki classification,abnormal compensatory vascular and cerebral hemorrhage as well as ischemic in adult Moyamoya disease

目的进一步探讨成人烟雾病患者脑出血及脑缺血事件的发生机制。方法对86例经全脑血管造影证实的成人烟雾病患者[脑出血52例(104个大脑半球,脑出血组),脑缺血34例(68个大脑半球,脑缺血组)]的临床资料进行回顾性分析,对Suzuki分级、烟雾样血管的丰富程度分期及颅内小动脉扩张不同者的脑出血及脑缺血发生率进行χ2检验及Mann-Whitney U检验。结果①两组Suzuki分级无显著差异,Mann-Whitney U检验Z=0.656、P=0.512;Suzuki分级Ⅲ～Ⅳ级者脑出血率显著高于脑缺血率(P<0.05)。②两组颅底烟雾样异常血管丰富程度分期有显著差异,Mann-Whitney U检验Z=3.909、P=0.000;其中2～4期者脑出血率显著高于脑缺血率(P<0.05)。③两组扩张小动脉无显著差异,Mann-Whitney U检验Z=1.183,P=0.237;同种血管扩张者脑出血率显著高于脑缺血率(P<0.05)。结论成人烟雾病患者脑出血及缺血发生与Suzuki分级无显著相关;烟雾样血管的丰富程度升高及颅内主要小动脉扩张预示脑出血事件发生的可能性大。

Objective To investigate the occurrence mechanism of cerebral hemorrhage as well as ischemia in adults with moyamoya disease. Methods A retrospective analysis of the clinical data of all 86 adult patients conformed with moy-amoya disease by cerebral angiography [ 52 cases of cerebral hemorrhage （the 104 cerebral hemispheres, cerebral hemor-rhage group） , 34 case of cerebral ischemia（ the 68 cerebral hemispheres, cerebral ischemia group） ] was made. All cases were confirmed separately by Suzuki classification and smog-like blood vessel degree as well as dilatation of small artery, the incidence rate of cerebral hemorrhage and ischemia were analyzed and dealt withx2 test and Mann-Whitney U test. Re-suits ①There was no statistical difference of Suzuki classification between the two groups, Mann-Whitney U test Z = 0. 656, P = 0.512; the occurrence of cerebral hemorrhage was higher than that of ischemia in patients with Suzuki classifi-cation Ⅲ and IV classification （P 〈 0.05）. ②There was statistic difference between periods of smog-like blood vessel de-gree for occurrence of cerebral hemorrhage and ischemia, Mann-Whitney U test Z = 3. 909, P = 0.000 ; occurrence of cere- bral hemorrhage were higher than that of ischemia in period 2-4 of smog-like blood vessel degree （ P 〈 0.05 ）. ③There was no statistical difference between dilatation of small artery for occurrence of cerebral hemorrhage and ischemia, Mann-Whit-ney U test Z = 1. 183, P = 0. 237 ; occurrence of cerebral hemorrhage were more than that of ischemia when one of them was dilated（ P 〈 0.05 ）. Conclusion There are no significant correlation between the incidence rate of cerebral hemorrhage as well as ischemia and Suzuki classification in adult patients with moyamoya disease; the incidence rate of cerebral hemor-rhage is high in patients with higher degree of smog-like blood vessel and dilatation of major intracranial small artery.