5例甲状腺功能亢进症合并烟雾病临床资料分析

Clinical data analysis of 5 cases of hyperthyroidism merge with moyamoya disease

目的通过对5例甲状腺功能亢进症合并烟雾病患者的临床资料分析,并结合相关文献,探讨甲亢合并烟雾病的发病机制、临床特征、治疗及预后,进一步提高对甲亢合并烟雾病的临床认识。方法对郑州大学第一附属医院2010年1月至2015年3月收治的5例甲亢合并烟雾病患者的临床资料进行回顾性分析并随访。结果 5例均为甲状腺功能异常的女性患者;对5例患者行头颅CT/MR等影像学检查均表现为脑缺血,大多为双侧,其中1例经脑DSA确诊并发现颅底烟雾状血管;治疗方面抗甲亢联合激素治疗2例,抗甲亢联合血管重建术治疗2例,单纯抗甲亢治疗1例。5例患者随诊0.5-2 a,均未再次出现神经系统缺血症状。结论甲状腺功能亢进症合并烟雾病主要见于年轻女性,临床症状以脑缺血多见,发病时甲状腺功能大多处于亢进状态,影像学检查大多表现为双侧颈内动脉末段及大脑前动脉及中动脉起始段的狭窄及闭塞。抗甲亢治疗,有助于脑缺血症状的改善,而激素有助于此病的治疗,行手术治疗可明显改善颅内血流。

Objective To analyze the clinical data of 5 cases of hyperthyroidism merge with moyamoya disease,combined with relevant literature,exploring the pathogenesis,clinical features,treatment and prognosis of hyperthyroidism with moyamoya disease to raise the awareness of the disease further. Methods The clinical data of 5 cases of hyperthyroidism merge with moyamoya disease in the First Affiliated Hospital of Zhengzhou University from January of 2010 to March of 2015 were retrospectively analyzed. Results 5 patients were all female,and the thyroid function was abnormal. All patients showed cerebral infarction by CT or MR and had bilateral lesions. 1 case was with skull smoke shape angiogenesis. 2 cases adopted antithyroid therapy combined with hormone therapy,2 cases utilized antithyroid with revascularization,1 case only applied antithyroid treatment. 5 patients were follow- up visited from 5 months to 2 years,neurological ischemic symptoms did not happen again. Conclusion Hyperthyroidism merger moyamoya disease is mainly found in young women,the clinical symptoms of cerebral ischemic symptoms are more common,and the thyroid function is mostly in hyperthyroidism state during the incidence of this disease. The last paragraph of bilateral carotid artery and initial segment of anterior cerebral artery or middle cerebral artery are different degrees of stenosis; Antithyroid treatment can improve cerebral ischemic symptoms,and hormones contribute to the treatment of this disease,surgical treatment can significantly improve intracranial blood flow.