血管性眩晕患者脑DSA结果的病因分析

The etiological analysis of DSA results of vascular vertigo patients

目的根据脑数字减影血管造影(digital subtraction angiography,DSA)结果,探讨导致血管性眩晕的病因。方法选择神经内科住院治疗并行脑DSA检查的血管性眩晕患者211例。收集临床资料后,根据脑DSA结果分析血管性眩晕的病因以及椎动脉V1段迂曲的关系。结果脑DSA结果异常94例,包括血管狭窄(狭窄率≥30%)85例(40.3%),锁骨下动脉盗血综合征5例(2.4%),烟雾病2例(0.9%),动脉瘤9例(4.3%),蛛网膜下腔出血1例(0.5%),动静脉瘘1例(0.5%)。椎动脉V1段迂曲180例(85.3%),且与性别、年龄、高血压之间的比较,差异有统计学意义(P<0.05),与高血脂、2型糖尿病、冠心病、脑梗死、TIA及DSA异常的比较,差异无统计学意义(P>0.05)。结论头颈部血管狭窄、TIA是血管性眩晕的常见病因,动脉瘤、蛛网膜下腔出血、烟雾病、动静脉瘘是血管性眩晕的少见病因;椎动脉迂曲导致后循环血液动力发生改变,可出现血管性眩晕。椎动脉迂曲与代谢性疾病尚不相关,而女性、老龄、高血压病史是椎动脉迂曲的危险因素。

Objective According to the results of cerebral digital subtraction angiography（ DSA）,the etiology of vascular vertigo was discussed. Methods 211 vascular vertigo patients who were underwent cerebral DSA in our neurology department were chosen in this study. After collecting their clinical data,the etiology of vascular vertigo and the risk factors of circuity of vertebral artery V1 segment were analyzed according to the results of cerebral angiography. Results 94 cases with abnormal results of cerebral DSA,including 85 cases（ 40. 3%） with vascular stenosis（ stenosis rate of 30% or higher）,5 cases（ 2. 4%） with subclavian steal syndrome,2 cases（ 0. 9%） with moyamoya disease,9 cases（ 4. 3%） with aneurysm,1 case（ 0. 5%） with subarachnoid hemorrhage,1 case（ 0. 5%） with arteriovenous fistula. 180 cases（ 85. 3%）showed the circuity of vertebral artery V1 segment and there was a statistically significant difference compared with sex、age、hypertension. There was no statistically significant difference compared with high cholesterol、type 2 diabetes、coronary heart disease、cerebral infarction、TIA and abnormal results of cerebral DSA. Conclusion The head and neck vascular stenosis and TIA are common causes of vascular vertigo. Aneurysm、subarachnoid hemorrhage、moyamoya disease and arteriovenous fistula are rare causes. Vertebral artery circuity result in the change of posterior circulation blood dynamic,which leads to vascular vertigo. Vertebral artery circuity is not relevant with metabolic diseases,however,women、aging and hypertension are risk factors for vertebral artery circuity.