摘要
目的对比分析颅内外动脉夹层的临床特征及潜在危险因素。方法前瞻性收集2010—2019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241例头颈动脉夹层患者,按照夹层部位将患者分为颅外动脉夹层(EAD)组和颅内动脉夹层(IAD)组,241例患者中,EAD组81例,IAD组160例。比较两组患者临床特征及危险因素的差异。结果IAD组缺血性脑卒中患者NIHSS分较高(P=0.015),头痛(58.8%比37.0%,P<0.001)、夹层动脉瘤(76.3%比38.3%,P<0.001)更常见。而EAD组患者多有头颈部轻微伤病史(11.1%比4.4%,P=0.047)并常累及前循环(77.8%比20.0%,P<0.001)。多因素Logistic回归分析结果显示头颈部轻微创伤史(OR=3.53,95%CI 1.04~11.97,P=0.042)、累及前循环(OR=0.09,95%CI 0.05~0.19,P<0.001)、夹层动脉瘤(OR=4.98,95%CI 2.80~8.84,P<0.001)、头痛(OR=2.42,95%CI 1.39~4.20,P=0.002)这些差异有统计学意义,而NHISS评分差异无统计学意义。结论EAD常累及前循环,既往多合并头颈部轻微伤病史,IAD更易出现头痛症状,更易形成夹层动脉瘤,缺血性脑卒中症状较重。
Objective To compare and analyze the clinical features and potential risk factors of intracranial and extracranial arterial dissection.Methods A total of 241 consecutive patients with cervicocerebral artery dissection(CAD)in the First Affiliated Hospital of Zhengzhou University from 2010 to 2019 were observed.The 241 CAD patients were divided into extracranial artery dissection group(EAD)(n=81)and intracranial artery dissection group(IAD)(n=160),clinical characteristics and risk factors were compared between the two groups.Results Compared with EAD,the National Institute of Health Stroke Scale(NIHSS)score was higher in patients with ischemic stroke in the IAD group(P=0.015).Patients with IAD were more likely to present with headache(58.8%vs 37.0%,P<0.001),and dissection Aneurysms(76.3%vs 38.3%,P<0.001).Patients with EAD more likely to have a history of mild head and neck injuries(11.1%vs 4.4%,P=0.047)and often involved the anterior circulation(77.8%vs 20.0%,P<0.001).Multivariate Logistic regression analysis showed differences in a history of minor head and neck trauma(OR=3.53,95%CI 1.04-11.97,P=0.042),anterior circulation involvement(OR=0.09,95%CI 0.05-0.19,P<0.001),dissection aneurysms(OR=4.98,95%CI 2.80-8.84,P<0.001),headache(OR=2.42,95%CI 1.39-4.20,P=0.002)remained significant,and the NHISS score lost its significance.Conclusions EAD often involves the anterior circulation and a history of mild injury to the head and neck.IAD is more prone to exhibit headache symptoms,and it is more likely to form a dissection aneurysm,and the symptoms of ischemic stroke are more severe.
作者
时银平
王玉涵
承文超
张巧漫
许佳
连亚军
Shi Yinping;Wang Yuhan;Cheng Wenchao;Zhang Qiaoman;Xu Jia;Lian Yajun(Department of Neurology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第5期345-350,共6页
National Medical Journal of China
基金
国家自然科学基金面上项目(81771397)。
关键词
颅内动脉夹层
颅外动脉夹层
临床特征
危险因素分析
Intracranial artery dissection
Extracranial artery dissection
Clinical characteristics
Risk factor analysis
