脑微出血与椎-基底动脉形态在脑干梗死中的相关性研究

Correlation study of cerebral microbleeds and morphological of vertebral basilar artery in brainstem infarction

目的研究脑干梗死患者脑微出血(CMBs)与椎-基底动脉形态的关系。方法对204例脑干梗死患者行头颅MRI+磁敏感加权成像(SWI)及头颈MRA检查,根据CMBs情况将患者分为脑干CMBs阳性组与阴性组。比较两组椎-基底动脉形态特点,分析脑干梗死患者CMBs与椎-基底动脉形态独立相关因素。结果头颅SWI检查结果显示,112例患者有脑干CMBs(阳性组),92例脑干无CMBs(阴性组)。阳性组椎-基底动脉异常发生率(78.6%)显著高于阴性组(58.7%)(χ~2=9.432,P=0.002)。与阴性组比较,阳性组椎动脉狭窄、椎动脉发育不良及基底动脉迂曲、延长的比率显著增高(均P<0.05)。Logistic回归分析显示,椎动脉发育不良、基底动脉迂曲延长是脑干脑CMBs的独立危险因素(OR=1.859,95CI%:1.056~3.270,P=0.032;OR=1.745,95CI%:1.010~3.018,P=0.046)。结论伴有椎-基底动脉形态异常脑干梗死患者脑干CMBs发生率高。脑干CMBs与椎动脉发育不良、基底动脉迂曲延长独立相关。

Objective To study the relationship between cerebral microbleeds（ CMBs） and morphological of vertebral basilar artery in patients with brainstem infarction. Methods Brain MRI ＋ magnetic susceptibility weighted imaging（ SWI） and brain and neck MRA examination were performed in 204 patients with brainstem infarction.According to SWI features,the patients were divided into CMBs positive group and negative group. The morphological characteristics of vertebral basilar artery were compared between the two groups,and the related factors of CMBs and vertebral basilar artery morphological in patients with brainstem infarction were analyzed. Results Brain SWI examination show that there were 112 patients with brainstem CMBs（ positive group）,92 patients without brainstem CMBs（ negative group）. The vertebral basilar artery abnormal rate（ 78. 6%） in positive group was significantly higher than that in negative group（ 58. 7%）（ χ2= 9. 432,P = 0. 002）. Compared with negative group,the ratio of vertebral artery stenosis,vertebral artery hypoplasia,basilar artery tortuous and prolonged in positive group were significantly higher（ all P 0. 05）. Logistic regression analysis indicated that vertebral artery hypoplasia,basilar artery tortuosity and prolonged were independent risk factors of brainstem CMBs（ OR = 1. 859,95% CI： 1. 056-3. 270,P = 0. 032; OR = 0. 046,95% CI： 1. 010-3. 018,P = 0. 046）. Conclusions The incidence of CMBs in patients with brainstem infarction accompanied by abnormal vertebral basilar artery is higher. Brainstem CMBs is independently related with vertebral artery hypoplasia,basilar artery tortuous and prolonged.