颈内动脉夹层与椎动脉夹层的临床表现及危险因素对比分析

Comparative analysis of clinical manifestations and risk factors of internal carotid artery dissection and vertebral artery dissection

目的对比分析颈内动脉夹层与椎动脉夹层的临床表现及危险因素。方法前瞻性收集2011-01—2019-10年于郑州大学第一附属医院神经内科和神经介入科连续诊治的216例头颈动脉夹层患者,根据夹层累及部位将患者分为颈内动脉夹层组和椎动脉夹层组,分析2组患者的临床表现及危险因素的差异。结果216例患者中颈内动脉夹层组100例,椎动脉夹层组116例。颈内动脉夹层组缺血性脑卒中患者NIHSS评分较高(3.9±5.2分比1.9±2.0分,P<0.001),而椎动脉夹层组患者多有头痛(67.2%比37.0%,P<0.001),轻微创伤史(14.7%比8.0%,P=0.021),并易出现SAH(24.1%比3.0%,P<0.001)。结论颈内动脉夹层缺血性脑卒中症状较重,椎动脉夹层更易出现头痛症状以及蛛网膜下腔出血,既往多有轻微创伤史。

Objective Comparative analysis of clinical characteristics and risk factors of internal carotid artery dissection and vertebral artery dissection.Methods A total of 216 consecutive patients with cervicocerebral artery dissection(CAD)in the First Affiliated Hospital of Zhengzhou University from January 2011 to October 2019 were observed.The patients were divided into the internal carotid artery dissection group and the vertebral artery dissection group according to the dissection involved.The clinical characteristics and risk factors of the two groups were analyzed.Results Among the 216 patients,there were 100 cases in the internal carotid artery dissection group and 116 cases in the vertebral artery dissection group.Patients with ischemic stroke in the internal carotid dissection group had higher NIHSS scores(3.9±5.2 vs.1.9±2.0,P<0.001),while patients in the vertebral dissection group had more headaches(67.2%vs 37.0%,P<0.001),a history of minor trauma(14.7%vs 8.0%,P=0.021),and were prone to SAH(24.1%vs 3.0%,P<0.001).Conclusion The symptoms of ischemic stroke of internal carotid artery dissection are more severe.Vertebral artery dissection is more prone to headache symptoms and subarachnoid hemorrhage,and has a history of mild head and neck trauma.