椎动脉优势对基底动脉形态及血管性眩晕的影响

Vertebral artery dominance affects basflar artery curvature and vascular vertigo

目的探讨椎动脉优势对基底动脉形态及血管性眩晕的影响，了解椎动脉优势导致眩晕的可能机制。方法选择扬州市都江人民医院神经内科自2011年6月至2013年5月收治的57例后循环血管性眩晕患者，根据头部血管成像检查结果，分为椎动脉优势组（28例）和非椎动脉优势组（29例）。收集所有患者临床资料，对其眩晕程度进行分级，分析2组患者椎一基底动脉情况及与血管性眩晕的关系。结果在28例椎动脉优势中，左侧优势21例（75％），右侧优势7例（25％），差异有统计学意义（x2=8．361，P=0．001）；2侧基底动脉形状总体弯曲比例差异有统计学意义（x2=7．729，P=0．006）；椎动脉优势者大多为C型弯曲，少数为S型和反C型弯曲。椎动脉优势组和非优势组比较，优势组基底动脉弯曲比例（85．71％）高于非优势组（31．03％），差异有统计学意义（x2=18．196，P=0．000）；基底动脉直径（4．68±0．57）mm、基底动脉弯曲度（3．50±0．93）mm大于非优势组，差异有统计学意义（t=6．289，P=O．015；t=4．621，P=0．036）。椎动脉优势组眩晕严重等级高于非优势组，差异有统计学意义（t=4．386，P=0．041）。眩晕严重等级与基底动脉弯曲程度和椎动脉直径差异程度呈正相关（r=0．328，P=0．013；r=0．458，P=0．002）。结论椎动脉优势患者基底动脉弯曲比例高、眩晕程度级别高：椎动脉优势与后循环血管性眩晕有相关性。

Objective To explore the effect of vertebral artery dominance on basilar artery morphology and vascular vertigo, and understand the possible mechanisms. Methods Fifty-seven patients with vascular vertigo, admitted to our hospital from June 2011 to May 2013, were selected in our study; according to the head CTA vascular imaging, they were divided into vertebral artery dominance group （n=28） and vertebral artery non-dominance group （n=29）. The clinical information and vertigo degrees from all of the patients were collected to analyze the vertebral-basilar artery and its relationship with vascular vertigo. Results In 28 patients with vertebral artery dominance, the left side of the dominance was noted in 21 patients （75%） and the fight side of the dominance in 7 （25%）, with statistically significant difference （X2= 8.361, P=0.001）; statistical significance of curve rate on both sides of the basal artery morphology was noted （x2=7.729, P=-0.006）. Most of its characteristic dominance of vertebral artery was C type, and the minority was S type and non-C type. The rate of basal artery bent in the dominant group was significantly higher than that in the non-dominant group （85.71% and 31.03%, ）（2=18.196, P=0.000）. The diameter （4.68±0.57 ram） and basal artery tortuosity （3.50±0.93 mm） in the dominant group were significantly larger than those in the non-dominant group （4.11±0.37 and 1.72±0.57, t=6.289, P=0.015; t=4.621, P=0.036）. The theory length of basal artery showed no statistical significance between the two groups （P〉0.05）. The greater the differences of both sides of the vertebral artery diameter, and the more obvious the basal diameter and basal artery tortuosity （P〈0.05）. The level of vertigo in the non-dominant group was significantly higher than that in the dominant group （t=4.386, P=0. 041）. Vertigo severity level was positively associated with basal artery tortuosity and vertebral artery diameter （r=0.328, P=0.013; r=0.458, P=0.002）. Conclusions There is higher rate of bending degree level and dizziness in patients of dominance of vertebral artery. Vertebral artery dominance is associated with vascular vertigo.