基底动脉延长扩张症的临床分析

Clinical manifestation of basilar dolichoectasia： a retrospective study

目的 分析症状性和非症状性基底动脉延长扩张症（BD）患者的临床表现、检验及影像学方面的差异.方法 回顾分析2012年1月至2013年1月行头颅磁共振血管造影或CT血管造影检查的1044例住院患者,从影像上进行BD判断,根据临床表现分为症状组与非症状组,以及血管性症状者和压迫症状者,分别对两组进行基线数据的对比,包括年龄、性别、血管危险因素、血糖、血脂、血压、尿酸、肾功能等.结果 76例患者符合BD诊断,症状性BD患者（n=24）的基底动脉直径大于非症状性BD者[n =52;（4.7-±0.9） mm与（4.2±1.0）mm,t=-2.289,P=0.025].症状性BD患者的舒张压、尿酸水平[分别为（94.0±16.7） mmHg与（86.9 ±12.0） mmHg,1 mmHg =0.133kPa,t=-2.113,P=0.038;（333.3±120.7）μmol/L与（267.6±84.6）μmol/L,t=-2.724,P=0.008]均较非症状性BD者增高.血管性症状的患者（n=18）基底动脉直径显著大于无血管性症状者[n=58;（4.9±0.8）mm与（4.2±1.0） mm,t=-2.612,P＜0.05].压迫症状组患者（n=6）尿酸[（374.5±51.9） μmol/L与（281.1±101.6） μmol/L,t=-2.216,P＜0.05]及血IgA水平[（1.44±0.28） g/L与（2.48±0.78） g/L,=5.660,P＜0.05]都高于非压迫症状组（n=70）.结论 BD患者有无临床症状与基底动脉直径相关,症状性BD患者的基底动脉直径更宽.对BD患者尽早严格控制血压可能有利于减少症状（尤其是血管性症状）的发生率,对尿酸增高的BD患者可考虑降尿酸治疗.

Objective To investigate the differences in clinical manifestation,laboratory test and imaging between patients with symptomatic and non-symptomatic basilar dolichoectasia （BD）.Methods We retrospectively analyzed the patients admitted in our hospital from January 2012 to January 2013,who receiving intracranial computed tomography angiography or magnet resonance angiography.We grouped the patients to symptomatic and non-symptomatic,and further divided the symptoms into vascular events and compressive symptoms.We compared the baseline characteristics of the symptoms in these groups,risk factors of cerebrovascular events,and kidney function between patients with symptomatic and nonsymptomatic BD.Results Comparing with non-symptomatic BD （n--24）,the diameter of basilar artery in symptomatic BD patients（n =52） was larger （（4.7 ± 0.9） mm vs （4.2 ± 1.0） mm,t =-2.289,P =0.025）,and the level of diastolic blood pressure and uric acid were higher （（94.0 ± 16.7） mmHg vs （86.9--±12.0） mmHg,1 mmHg =0.133 kPa,t =-2.113,P =0.038;（333.3 ± 120.7） μmol/L vs （267.6 ± 84.6） μmol/L,t =-2.724,P =0.008）.The group with vascular symptoms （n =18） had greater basilar artery diameter （（4.9 ±0.8） mm vs （4.2 ± 1.0） mm,t =-2.612,P ＜0.05） compared to those without vascular symptoms（n =58）.BD patients with compressive symptoms （n =6） had higher level of uric acid （（374.5 ± 51.9） μmol/L vs （281.1 ± 101.6） μmol/L,t =-2.216,P ＜ 0.05） and serum IgA （（1.44 ± 0.28） g/L vs （2.48 ± 0.78） g/L,t =5.660,P ＜ 0.05） than those with non-compressive symptoms （n =70）.Conclusions The presence of symptoms in patients with BD is related with the increased diameter of basilar artery.Our results suggest that strict control of blood pressure in the early stage may help to reduce the incidence of the vascular events in BD patients.