CAJ | 학술논문

目的分析儿童出血型烟雾病的损伤模式。 　　方法回顾性分析中国人民解放军第307医院2002年12月～2011年12月收治的26例出血型烟雾病患儿，根据出血部位发生丘脑出血2例，非丘脑性脑实质出血（基底节和脑叶）3例，脑室出血21例。按照改良的Morioka分级对所有患者的脑血管造影的出血侧脉络膜前动脉和后交通动脉（anterior choroidal artery and posterior communicating artery，AChA-PComA）进行分级，并分析出血病灶分布模式与出血侧AChA-PComA分级及脉络膜后动脉分级的关系。 　　结果所有患儿均发生1次出血。4例患儿合并动脉瘤，其中1例为大脑前动脉瘤，1例为脉络膜前动脉瘤，2例为脉络膜后动脉瘤；所对应出血类型均为脑室出血。AChA-PComA正常或轻度扩张阶段，非丘脑性脑实质出血比例最大（2/3，66.7%），脉络膜后动脉均未显影；AChA-PComA极度扩张和延长阶段，脑室出血所占比例最大（16/17，94.1%）（P＜0.05），脉络膜后动脉均未显影；AChA-PComA未显影阶段，脑室出血比例仍最大（4/6，66.7%），其次为丘脑出血（2/6，33.3%），脉络膜后动脉均表现为极度扩张和延长（P＜0.05）。 　　结论儿童出血型烟雾病中出血类型主要为脑室出血；脑室出血患者相对其他出血类型AChA-PComA极度扩张和延长所占比例高；当颈内动脉在后交通动脉闭塞时即AChA-PComA未显影阶段，脉络膜后动脉均表现为扩张和延长。
　　목적분석인동출혈형연무병적손상모식。 　　방법회고성분석중국인민해방군제307의원2002년12월～2011년12월수치적26례출혈형연무병환인，근거출혈부위발생구뇌출혈2례，비구뇌성뇌실질출혈（기저절화뇌협）3례，뇌실출혈21례。안조개량적Morioka분급대소유환자적뇌혈관조영적출혈측맥락막전동맥화후교통동맥（anterior choroidal artery and posterior communicating artery，AChA-PComA）진행분급，병분석출혈병조분포모식여출혈측AChA-PComA분급급맥락막후동맥분급적관계。 　　결과소유환인균발생1차출혈。4례환인합병동맥류，기중1례위대뇌전동맥류，1례위맥락막전동맥류，2례위맥락막후동맥류；소대응출혈류형균위뇌실출혈。AChA-PComA정상혹경도확장계단，비구뇌성뇌실질출혈비례최대（2/3，66.7%），맥락막후동맥균미현영；AChA-PComA겁도확장화연장계단，뇌실출혈소점비례최대（16/17，94.1%）（P＜0.05），맥락막후동맥균미현영；AChA-PComA미현영계단，뇌실출혈비례잉최대（4/6，66.7%），기차위구뇌출혈（2/6，33.3%），맥락막후동맥균표현위겁도확장화연장（P＜0.05）。 　　결론인동출혈형연무병중출혈류형주요위뇌실출혈；뇌실출혈환자상대기타출혈류형AChA-PComA겁도확장화연장소점비례고；당경내동맥재후교통동맥폐새시즉AChA-PComA미현영계단，맥락막후동맥균표현위확장화연장。
Objective To analyze the lesion patterns of hemorrhagic type of moyamoya disease in children. Methods The clinical and imaging data of 26 hemorrhagic type patients among 450 pediatric patients with moyamoya disease from December 2002 to December 2011 were analyzed retrospectively. According the location of hemorrhage, moyamoya disease patients were classified into three types, thalamic in 2 patients, non-thalamic parenchymal (basal ganglia and cerebral lobe) in 3 patients, primary ventricular hemorrhage in 21 patients. All patients received digital silhouette angiography (DSA). The ipsilateral anterior choroidal artery and posterior communicating artery (AChA-PComA) were evaluated by the modified Morioka's 3-points grading system. The distribution of lesion patterns and the relationship with AChA-PComA and posterior choroidal artery (PChA) were analyzed. Results All the patients suffered one episode of bleeding. A total of 4 patients complicated with aneurysms, 1 was located in the anterior cerebral artery, 1 in the anterior choroidal artery, 2 in the PChA. In the stage of normal or mild dilation, the non-thalamic parenchymal type was the most frequent type (2/3, 66.7%), the PChA were all in stage 1;in the stage of severe dilation with abnormal extension, intraventricular hemorrhage was most common (16/17, 94.1%), the PChA were all in stage 1;in the stage of non-visualization, intraventricular hemorrhage was still the most common type (4/6, 66.7%), others were found in thalamus (2/6, 33.3%). The PChA all manifested dilation and branch extension (P<0.05). Conclusion Intraventricular hemorrhage was the most common type in pediatric hemorrhagic moyamoya patients; compared with other lesion patterns, the dilation and branch extension of AChA-PComA accounted for a large proportion;in the stage of non-visualization of AChA-PComA, PChA all showed dilation and branch extension.