摘要
目的探讨成人缺血型烟雾病患者联合手术术后脑梗死的影像学危险因素。方法回顾性分析2015年10月至2020年10月北京大学国际医院神经外科18岁及以上的成年烟雾病手术患者的临床资料。239例患者男120例,女119例,年龄为18~63(41.7±10.3)岁。共239例(290例次)患者采用直接与间接联合血管重建术(CR)。比较术后1周内发生脑梗死(48例次)与未发生脑梗死患者(242例次)的性别、年龄、手术侧别、术前短暂性脑缺血发作(TIA)、是否有陈旧性梗死灶,以及影像学表现等。采用多因素logistic回归模型分析术后脑梗死的影像学危险因素。结果290例次CR组中,术后1周内48例次(16.5%)发生脑梗死。CR术后脑梗死组患者术前有TIA、陈旧性脑梗死、颈内动脉(ICA)狭窄、A1段狭窄、M1段狭窄、大脑后动脉(PCA)异常及不稳定代偿的占比高于无脑梗死组(均P<0.05)。术前TIA(OR=4.514,95%CI:1.920~10.611)、陈旧性脑梗死(OR=2.856,95%CI:1.176~6.936)、A1狭窄(OR=7.027,95%CI:1.877~26.308)、M1狭窄(OR=6.968,95%CI:2.162~22.459)、PCA异常(OR=4.114,95%CI:1.330~12.728)、不稳定代偿(OR=4.488,95%CI 1.194~16.865)是CR术后脑梗死的危险因素(均P<0.05)。结论影像学因素中TIA、陈旧性脑梗死、ICA狭窄、A1段狭窄、M1段狭窄、PCA异常及不稳定代偿是联合方式手术治疗成人烟雾病术后脑梗死的危险因素。
Objective To investigate the imaging factors associated with postoperative cerebral infarction in adult patients aged 18 and above with ischemic Moyamoya disease.Methods The clinical data of adult patients who underwent surgeries for ischemic Moyamoya disease in the Department of Neurosurgery at Peking University International Hospital from October 2015 to October 2020 were retrospectively analyzed.Of the 239 patients,120 were male and 119 were female,with ages ranging from 18 to 63(41.7±10.3)years.A total of 239 patients(290 cases)underwent direct and indirect combined revascularization(CR).Gender,age,surgical side,preoperative transient ischemic attack(TIA),presence of old cerebral infarction,and imaging features were compared between the patients with(48 cases)and without(242 cases)cerebral infarction within 1 week after surgery.Multivariate logistic binary regression model was used to analyze the imaging risk factors of postoperative cerebral infarction.Results Cerebral infarction occurred in 48 cases(16.5%)among the 290 CR group within 1 week after surgery.The proportion of patients with TIA,old cerebral infarction,ICA stenosis,A1 segment stenosis,M1 segment stenosis,abnormal posterior cerebral artery(PCA),and unstable compensation before CR in the cerebral infarction group was higher than that in the non-cerebral infarction group(P<0.05).Preoperative TIA(OR=4.514,95%CI:1.920-10.611),old cerebral infarction(OR=2.856,95%CI:1.176-6.936),A1 stenosis(OR=7.027,95%CI:1.877-26.308),M1 stenosis(OR=6.968,95%CI:2.162-22.459),abnormal PCA(OR=4.114,95%CI:1.330-12.728)and unstable compensation(OR=4.488,95%CI:1.194-16.865)were risk factors for cerebral infarction after CR surgery(all P<0.05).Conclusion Among the imaging factors,TIA,old cerebral infarction,A1 stenosis,M1 stenosis,abnormal PCA and unstable compensation were risk factors for cerebral infarction in adult patients with ischemic Moyamoya disease treated by combined revascularization.
作者
于腾飞
叶迅
曾春
陈晓霖
赵元立
Yu Tengfei;Ye Xun;Zeng Chun;Chen Xiaolin;ZhaoYuanli(Department of Neurosurgery,Peking University International Hospital,Beijing 102206,China;Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Peking Union Medical College Hospital,Beijing 100730,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第15期1310-1315,共6页
National Medical Journal of China
关键词
烟雾病
联合方式重建血管术
脑梗死
影像学因素
横断面研究
Moyamoya disease
Combined revascularization
Brain infarction
Imaging factors
Cross-sectional study
