不稳定型烟雾病患者的临床特征及其发生的危险因素分析

Study on clinical characteristics and risk factors of unstable moyamoya disease

目的对不稳定型烟雾病患者的临床特征和其发生的危险因素进行探讨。方法回顾性分析河南省人民医院烟雾病诊疗中心自2019年1月1日至2019年12月31日接受联合脑血流重建烟雾病患者261例的临床资料,比较稳定型组和不稳定型组的临床变量,总结不稳定型烟雾病临床特征,采用单因素和多因素Logistic回归分析归纳不稳定型烟雾病的危险因素。结果术前频繁短暂性脑缺血发作(TIA;OR=3.439,P=0.023)、收缩压(OR=1.097,P<0.001)是患者发生不稳定型烟雾病的危险因素。不稳定组术后新发卒中事件的发生率为42.31%(11/26),较稳定型烟雾病的3.40%(8/235),表现出了更高的术后再发卒中事件(χ2=39.133,P<0.001)。结论不稳定型烟雾病在影像学上具有颅内双侧血管的不对称性改变,患者更容易出现术前TIA频繁发作和更高的难控性血压。在行联合脑血流重建术后更易出现新发卒中事件。对此类患者,应加强围手术期评估管理、制定详实的手术方案、完备术后并发症的预防,对降低烟雾病手术治疗的病死率和致残率有深远影响。

Objective To explore the clinical characteristics and risk factors of unstable moyamoya disease.Methods The clinical data of 261 patients with moyamoya disease,who received combined cerebral reconstruction in the Moyamoya Disease Center of Henan Provincial People's Hospital from January 1,2019 to December 31,2019,were analyzed retrospectively.The clinical variables of stable group and unstable group were compared,and the clinical characteristics of unstable moyamoya disease were summarized.Univariate and multivariate logistic regression analysis was used to summarize the risk factors of unstable moyamoya disease.Results The patients with unstable moyamoya disease showed higher frequency of preoperative TIA attacks(OR=3.439,P=0.023)and higher systolic blood pressure(OR=1.097,P<0.001).The incidence of new-onset postoperative stroke events in the unstable group was 42.31%(11/26),which was significantly higher than that of stable group(3.40%,8/235;χ2=39.133,P<0.001).Conclusion Unstable moyamoya disease has asymmetrical changes of bilateral intracranial vessels on imaging,and such patients are more likely to present frequent preoperative TIA attacks and higher uncontrollable blood pressure.New-onset stroke events are more likely to occur after combined cerebral blood flow reconstruction.For this group of patients,we should strengthen the perioperative evaluation management,implement detailed surgical plans and postoperative management to prevent complications,which is fundamental to reduce the mortality and disability of surgical treatment of moyamoya disease.