伴椎动脉发育不良的小脑梗死临床分析

Clinical analysis of cerebellar infarction with vertebral artery hypoplasia

目的：总结伴有椎动脉发育不良（VAH）的小脑梗死患者的临床特征和血管病变情况。方法采用回顾性分析方法，选择伴VAH和椎动脉粥样硬化狭窄率≥50%的初发小脑梗死患者，按照椎动脉病变分为VAH组（34例）和椎动脉狭窄组（椎动脉狭窄≥50%，37例），比较两组年龄、性别构成、危险因素、临床特征和脑血管病变特点等。结果两组在性别构成、年龄及合并冠心病等动脉硬化危险因素方面比较差异无统计学意义（P＞0.05）。两组入院时国立卫生研究院卒中量表（NIHSS）评分比较差异无统计学意义（P＞0.05）。VAH 组出现早期病情进展14例（41.2%，14/34），椎动脉狭窄组出现7例（18.9%，7/37），两组早期病情进展发生率比较差异有统计学意义（χ2=4.21，P＜0.05）。VAH组伴有颈内动脉系统血管狭窄≥50%病变的患者比例为35.3%（12/34），高于椎动脉狭窄组的13.5%（5/37），差异有统计学意义（χ2=4.62，P=0.03）。VAH组除病变侧椎动脉以外合并其他脑动脉狭窄≥50%的患者比例为44.1%（15/34），明显高于椎动脉狭窄组的13.5%（5/37），差异有统计学意义（χ2=8.20，P=0.00）。结论伴VAH的小脑梗死与椎动脉狭窄比较，合并其他脑动脉狭窄（狭窄率≥50%）的比例更高，在病程中更易出现早期病情进展。

Objective To summarize the clinical features and vascular lesions in patients who suffered from cerebellar infarction with vertebral artery hypoplasia（VAH）. Methods Retrospective analysis was used in the research. The selected patients suffered from cerebellar infarction with VAH or stenosis （stenosis rate≥50%）. Seventy-one patients with cerebellar infarction were enrolled. There were 34 patients in VAH group and 37 patients in vertebral artery stenosis group. The age, sex, risk factors, clinical manifestations and characteristics of vascular examination were compared. Results The age, sex, risk factors between two groups had no significant differences （P〉0.05）. The scores of National Institutes of Health Stroke Scale （NIHSS） between two groups had no significant difference （P〉0.05）. The proportion of early neurological deterioration in VAH group （41.2%, 14/34） was higher than that in vertebral artery stenosis group （18.9%, 7/37）, χ2=4.21, P〈0.05. There were more patients with anterior circulation artery stenosis in the VAH group （35.3%, 12/34）, compared with that in artery stenosis group （13.5%, 5/37）,χ2=4.62, P〈0.05. Except the ipsilateral vertebral artery, other arteries stenosis in VAH group （44.1%, 15/34） was significantly higher than that in vertebral artery stenosis group （13.5%, 5/37）,χ2=8.20, P〈0.05. Conclusions Cerebellar infarction with vertebral artery hypoplasia is more likely to have multiple cerebral arterial stenosis （stenosis rate ≥50%）. The patients who suffered from cerebellar infarction with vertebral artery hypoplasia might be prone to early neurological deterioration.