高血压患者脑干梗死与椎基底动脉系统斑块、狭窄的相关性研究

Correlation on Hyperpietic with Brain Stem Infarction and Vertebral-Basilar Atherosclerosis

目的探究高血压合并急性脑干梗死患者椎-基底动脉系统血管斑块、狭窄的特征及分布。方法搜集被诊断为急性脑干梗死的高血压患者及同期无脑梗死的门诊检查者各48例,所有受检者均行颅脑磁共振及头颈部CTA检查。采用χ^2检验比较两组之间血管斑块及狭窄的差异,Logistic回归分析探究血管病变特征及病变血管分布状况是否为脑干不同部位梗死的相关危险因素。结果梗死组患者检出不稳定斑块65个,对照组8个,梗死组不稳定斑块检出率高于对照组(P<0.05)。中脑梗死患者斑块主要位于基底动脉,检出率80.0%;延髓梗死患者斑块主要位于椎动脉,检出率83.3%,差异存在统计学意义(P值均<0.05)。梗死组重度狭窄-闭塞血管段数59段,对照组为9段,梗死组血管重度狭窄-闭塞发生率较对照组高(P<0.05)。中脑梗死血管以重度狭窄及闭塞为主,发生率37.3%;脑桥梗死以血管轻-中度狭窄为主,发生率64.2%(P值均<0.05)。椎基底动脉系统狭窄血管的分布与脑干梗死的位置具有一定关系:基底动脉狭窄与脑桥梗死、椎动脉狭窄与延髓梗死具有显著相关性(P<0.05),大脑后动脉狭窄是中脑梗死的重要因素(P<0.01)。结论不稳定斑块的形成及血管狭窄程度加剧与高血压患者脑干梗死的发生有关,椎基底动脉系统不同血管病变可能是脑干不同部位梗死的重要原因。

Objective To explore the characteristics and distribution of vascular plaque and stenosis in the vertebral-basal artery system in patients with hypertension and acute brainstem infarction.Methods A collection of 48 hypertensive patients diagnosed with acute brainstem infarction and 48 outpatients without cerebral infarction during the same period were collected.All subjects underwent cranial magnetic resonance and head and neck CTA examinations.Theχ^2 test was used to compare the differences in vascular plaque and stenosis between the two groups.Logistic regression analysis was used to explore whether the characteristics of vascular disease and the distribution of diseased blood vessels are related risk factors for infarction in different parts of the brainstem.Results 65 unstable plaques were detected in the infarct group and 8 in the control group.The detection rate of unstable plaques in the infarct group was higher than that in the control group(P<0.05).Plaques in patients with midbrain infarction are mainly located in the basilar artery,with a detection rate of 80.0%;in patients with bulbar infarction,plaques are mainly located in the vertebral artery,with a detection rate of 83.3%,the difference is statistically significant(all P values<0.05).The number of severe stenosis-occlusion in the infarct group was 59 segments,and the control group had 9 segments.The incidence of severe stenosis-occlusion in the infarction group was higher than that in the control group(P<0.05).The main types of middle cerebral infarction were severe stenosis and occlusion,and the incidence was 37.3%;the main type of pontine infarction was mild to moderate vascular stenosis,and the incidence was 64.2%(all P values<0.05).The distribution of the stenoses of the vertebrobasilar artery system has a certain relationship with the location of the brainstem infarction:basilar artery stenosis and pontine infarction,vertebral artery stenosis and bulbar infarction have a significant correlation(P<0.05),posterior cerebral artery stenosis is caused by midbrain infarction Important factors(P<0.01).Conclusion The formation of unstable plaques and the aggravation of vascular stenosis are related to the occurrence of brainstem infarction in patients with hypertension.Different vascular lesions in the vertebrobasilar system may be an important cause of infarction in different parts of the brainstem.