成人烟雾病不同治疗方式比较分析

Comparative Analysis of Treatment Methods for Adults with Moyamoya Disease

目的:探讨脑血管重建术与保守治疗相比是否能更好地预防成人烟雾病患者的再卒中及提高生存率。方法:纳入成年烟雾病患者279例,收集全部临床及回访资料,进行回顾性分析。结果:本组纳入血管重建组133例,纳入保守治疗组146例。血管重建组的平均年龄略低于保守治疗组(P<0.05)。血管重建组围手术期并发症15例(11.8%)。随访终点血管重建组mRS>2分、再卒中及死亡的患者数均少于保守治疗组(P<0.05)。血管重建组较保守治疗组再卒中发生率低(P=0.016)。血管重建组无卒中生存时间较保守治疗组长(P=0.014)。对于出血型患者,血管重建组中的无卒中生存时间明显长于保守治疗组(P=0.036);对于缺血型患者,2种治疗方式的无卒中生存时间差异无统计学意义(P>0.05)。结论:血管重建治疗组可改善烟雾病患者预后、降低卒中复发率,尤其在出血型患者中效果更为显著;对于缺血型患者,血管重建未观察到明显优势。

Objective:To investigate whether revascularization surgery can better prevent the recurrence of stroke and improve survival rate in adult patients with moyamoya disease compared to conservative treatment.Methods:The clinical data and follow-up results of 279 adult moyamoya patients were retrospectively analyzed.Results:In this study,133 patients underwent revascularization surgery and 146 patients received conservative treatment.The revascularization surgery patients showed a lower mean age than the conservative treatment patients(P<0.05).In the revascularization surgery group,15 patients(11.8%)developed complications during the perioperative period;at follow-up,the numbers of patients with a>2 mRS scores,recurrences of stroke,and deaths in the revascularization surgery group were lower than that in the conservative treatment group(P<0.05).The revascularization surgery group showed a lower rate of stroke recurrence compared to the conservative treatment group(P=0.016).The revascularization surgery group also showed a longer survival time without stroke than the conservative treatment group(P=0.014).In the subgroup analysis,survival time without stroke was significantly longer in the revascularization surgery group for hemorrhagic patients(P=0.036);survival time without stroke did not differ between treatment types for ischemic patients(P>0.05).Conclusion:Revascularization surgery is superior to conservative treatment in improving the prognosis and lowering the stroke recurrence rate in adult moyamoya patients and particularly in hemorrhagic-onset patients.For ischemic-type moyamoya,the benefits of revascularization surgery are less apparent.