不同症状成人烟雾病临床特点的比较

Comparison of the clinical characteristics in adult patients with moyamoya disease of different symptoms

目的 探讨不同症状成人烟雾病的临床特点。方法 根据症状将73例成人烟雾病患者分为脑梗死组（29例）及脑出血组（44例）,收集其临床资料,对临床表现、卒中部位、血管分期以及代偿模式进行分析。结果 与脑出血组比较,脑梗死组性别、年龄、家族史、既往史、吸烟史、饮酒史、血液生化指标差异无统计学意义。与脑梗死组比较,脑出血组出血部位在脑室和基底节的比率显著升高（χ~2=13.566,P=0.000）,皮质出血的比率显著降低（χ~2=8.815,P=0.003）;两组间皮质下区差异无统计学意义（χ~2=1.787,P=0.181）。脑出血组与脑梗死组患者均以颈内动脉病变为主,两组受累脑动脉比较均无统计学差异。与脑梗死组比较,脑出血组SuzukiⅤ期、Ⅵ期比率显著降低（均P=0.000）,Ⅲ期比率显著升高（P=0.004）;两组均以深穿支代偿最多,脑膜中动脉代偿最少;脑梗死组眼动脉代偿比率显著高于脑出血组（P=0.003）,两组间其他血管代偿方式差异无统计学意义。结论 成人烟雾病以脑出血多见,出血型常见部位为脑室及其周围,以血管Suzuki分期Ⅲ~Ⅳ多见;梗死型常见部位为皮质区,以血管Suzuki分期Ⅴ~Ⅵ多见。深穿支侧支模式在脑出血和脑梗死中均发挥重要的代偿作用,但脑梗死患者眼动脉代偿比率显著高于脑出血患者。

Objective To investigate the clinical characteristics in adult patients with moyamoya disease of different symptoms. Methods Sevety-three adult patients with moyamoya disease were divided into cerebral hemorrhage group（44 cases） and cerebral infarction group（29 cases） according to clinical manifestations. The clinical data were collected,and the clinical characteristics,localizations,vascular stage,compensatory models between two groups were analyzed. Results There were no siginificant differences in gender,age,history of family,medical,smoking,drinking,blood biochemical index between cerebral hemorrhage group and infarction group.Compared with cerebral hemorrhage group,the proportion of intraventricular and basal ganglia hemorrhage were significantly higher in cerebral infarction group（ χ~2= 13. 566,P = 0. 000）,while the rate of cortex lesion was significantly lower（χ~2= 8. 815,P = 0. 003）. There were no siginificant differences on subcortex zones between the two groups（χ~2= 1. 787,P = 0. 181）. Internal carotid artery was mainly lesion vessel in the two groups. For the lesion vessels,there was no significant differences between the two groups. Compared with cerebral infarction group,the compensatory vessels of Suzuki gradeⅤ and Ⅵ in cerebral hemorrhage group were significantly lower（ all P =0. 000）,while the compensatory vessels of Suzuki grade Ⅲ were significantly higher（ P = 0. 004）. Compensatory model via deep penetrating branches was the highest,and the lowest rate of compensation by middle meningeal artery between the two groups. Ophthalmic artery compensatory manner was significantly higher in cerebral infarction group than that in cerebral hemorrhage group（P = 0. 003）. There was no significant difference in the other models of compensation between the two groups. Conclusions Most onset of adult moyamoya diseases are cerebral hemorrhage.Cerebral hemorrhage located mainly in the ventricles and adjacent area,which the compensatory vessels of Suzuki grade Ⅲ- Ⅳ are common. However,the locations of cerebral infarction in the cortex with chief compensatory vessels are Suzuki grade Ⅴ- Ⅵ. The model via deep penetrating branches is played an important role in the compensation between cerebral hemorrhage and cerebral infarction, but ophthalmic artery compensatory manner in cerebral hemorrhage patients is significantly higher in cerebral infarction patients.