青年缺血性脑小血管病血管影像特点和危险因素分析

Imaging features and risk factors of youth ischemic cerebral small vessel disease

目的探讨青年缺血性脑小血管病的血管影像特点和危险因素，为青年脑卒中的防治提供依据。方法收集63例缺血性脑小血管病的15～45岁青年患者，头部MRI表现为腔隙性脑梗死和（或）脑白质病变，所有患者均进行了颅内或颈部血管256层螺旋CT血管造影和颈动脉超声检查。同时收集患者高血压、糖尿病、血脂异常、吸烟等常见危险因素的情况，分析青年缺血性脑小血管病的血管影像特点和危险因素。结果男性脑小血管病检出率（71．42％）明显高于女性（28．58％），差异有统计学意义（P〈0．01）。头部MRI病灶位于前循环区域明显较后循环区域多，差异有统计学意义（P〈0．01），多发病灶多见。头颈CT血管造影检查，66．67％的患者未发现明显的颅内外动脉狭窄或闭塞，明显高于伴有血管异常的患者（33．33％），差异有统计学意义（P〈0．01），其中存在血管狭窄或闭塞的患者71．43％位于前循环，28．57％位于后循环。危险因素分析发现，76．19％的患者颈部血管超声发现血管硬化表现（颈动脉内中膜增厚为56．25％，颈动脉斑块为31．25％，颈动脉管径增粗为12．50％）。57．14％的患者有高血压，52．38％的患者有血脂异常，38．10％的患者吸烟。结论青年缺血性脑小血管病好发于前循环供血区域的深穿支动脉，动脉硬化是重要原因。高血压、血脂异常、吸烟仍是青年缺血性脑小血管病常见的危险因素，要加以预防与控制。

Objective To explore the cerebrovascular imaging features and risk factors in young adults with ischemic cerebral small vessel disease. Methods Sixty-three cases （aged from 15 to 45 years） with MR signs of cerebral small vessel disease [lacunar infarction and （or） white matter lesions] were admitted in this study. All patients were performed cranial or carotid 256-slice CT angiography and carotid ultrasound examination. Risk factors including hypertension, diabetes, abnormal lipid and smoking also were assayed. These data were analyzed to determine the characters of distribution of the lesions, cerebrovascular lesions and risk faetors. Results The incidence in men （71.42%） was significantly higher than that in women （28.58%） （P〈0.01）. Head MRI showed that the lesions of the anterior circulation area were more frequently than that of the posterior circulation area （P〈0.01）. The prevalence of multiple lesions was significantly higher than single lesion （P〈0.01）. Cranial or carotid CT angiography showed that 66.67% of cases were normal, while 33.33% of cases were found vascular stenosis and （or） occlusion. 71.43% of vascular stenosis and （or） occlusion involved the anterior circulation, while 28.57% involved of posterior circulation. Risk factors analysis showed that atherosclerosis was found in 76.19% of the cases by carotid ultrasound （carotid artery intima thickening 56.25%, carotid plaque 31.25%, the enlarged carotid artery lumen 12.50%）. 57.14% of the cases had hypertension, 52.38% of patients had abnormal lipid metabolism, 38.09% of the patients were smokers. Conclusion Youth ischemic cerebrovaseular disease occurs in deep perforating artery in anterior circulation area, atherosclerosis is an important reason. Hypertension, abnormal lipid metabolism,smoking are still common risk factors in youth isehemic cerebrovascular disease, which should be prevented and controlled.