CAJ | 학술논문

目的利用计算机断层扫描血管成像（computed tomography angiography，CTA）及计算机断层扫描灌注成像（computed tomography perfusion，CTP）技术研究Wilis环侧支建立情况在急性缺血性脑血管病中的代偿及灌注差异。方法本研究为回顾性研究，连续纳入首都医科大学附属北京友谊医院神经内科2011年12月～2013年2月期间住院的急性缺血性脑血管病患者231例，根据颅脑磁共振弥散加权成像（diffusion weighted imaging，DWI）有无高信号将患者分为脑梗死（cerebral infarction，CI）组和短暂性脑缺血发作（transient ischemic attack，TIA）组，并进一步根据缺血症状或梗死部位分为前、后循环TIA组及前、后循环CI组。其中前循环TIA组59例，后循环TIA组66例，前循环CI组57例，后循环CI组49例，收集所有患者的CTA和CTP资料，记录患者的Wil is环代偿情况，并将其分为Ⅰ型（对称型）、Ⅱ型（前部不完整）、Ⅲ型（后部不完整）、Ⅳ型（混合不完整）。分析Wil is环不同分型及完整性与上述4组之间的关系。结果所有患者按Wilis环形态分4型（Ⅰ型占7.8%、Ⅱ型占4.3%、Ⅲ型占38.5%、Ⅳ型占49.4%）。TIA组与CI组相比，Ⅰ型、Ⅲ型Wil is环多（4组中Ⅰ型和Ⅲ型所占比例分别为11.86%，7.58%，2.83%，2.83%及49.15%，46.96%，16.03%，11.32%）。前交通动脉显示率在TIA组中更高（χ2=10.832，P=0.001），灌注异常者中以Ⅳ型所占比例最高（60.33%），Ⅰ、Ⅱ、Ⅲ型所占比例低于灌注正常组（χ2=12.356， P=0.006）。结论不同Wilis环结构的比例存在差异，其中以Ⅲ型、Ⅳ型最为多见。在发生急性缺血性脑血管病时，前交通的开放可能起到一定的代偿作用，Wil is环不完整的患者出现灌注异常的情况更多见。
목적이용계산궤단층소묘혈관성상（computed tomography angiography，CTA）급계산궤단층소묘관주성상（computed tomography perfusion，CTP）기술연구Wilis배측지건립정황재급성결혈성뇌혈관병중적대상급관주차이。방법본연구위회고성연구，련속납입수도의과대학부속북경우의의원신경내과2011년12월～2013년2월기간주원적급성결혈성뇌혈관병환자231례，근거로뇌자공진미산가권성상（diffusion weighted imaging，DWI）유무고신호장환자분위뇌경사（cerebral infarction，CI）조화단잠성뇌결혈발작（transient ischemic attack，TIA）조，병진일보근거결혈증상혹경사부위분위전、후순배TIA조급전、후순배CI조。기중전순배TIA조59례，후순배TIA조66례，전순배CI조57례，후순배CI조49례，수집소유환자적CTA화CTP자료，기록환자적Wil is배대상정황，병장기분위Ⅰ형（대칭형）、Ⅱ형（전부불완정）、Ⅲ형（후부불완정）、Ⅳ형（혼합불완정）。분석Wil is배불동분형급완정성여상술4조지간적관계。결과소유환자안Wilis배형태분4형（Ⅰ형점7.8%、Ⅱ형점4.3%、Ⅲ형점38.5%、Ⅳ형점49.4%）。TIA조여CI조상비，Ⅰ형、Ⅲ형Wil is배다（4조중Ⅰ형화Ⅲ형소점비례분별위11.86%，7.58%，2.83%，2.83%급49.15%，46.96%，16.03%，11.32%）。전교통동맥현시솔재TIA조중경고（χ2=10.832，P=0.001），관주이상자중이Ⅳ형소점비례최고（60.33%），Ⅰ、Ⅱ、Ⅲ형소점비례저우관주정상조（χ2=12.356， P=0.006）。결론불동Wilis배결구적비례존재차이，기중이Ⅲ형、Ⅳ형최위다견。재발생급성결혈성뇌혈관병시，전교통적개방가능기도일정적대상작용，Wil is배불완정적환자출현관주이상적정황경다견。
Objective To investigate the compensatory and perfusion differences in acute ischemic cerebrovascular disease (ICVD) with collateral establishment of circle of Willis by computed tomography angiography (CTA) and computed tomography perfusion (CTP). Methods This retrospective study enrolled 231 patients with acute ICVD, who were treated in Beijing Friendship Hospital of Capital Medical University from December 2011 to February 2013. They were divided into cerebral infarction (CI) group and transient ischemic attack (TIA) group according to diffusion weighted imaging of magnetic resonance imaging. Based on their symptoms and imaging, the patients were divided into anterior circulation TIA (59 cases), posterior circulation TIA (66 cases), anterior CI (57 cases) and posterior CI (49 cases). Collect the data of CTA and CTP to describe the circle of Willis, and divide them into four types: (1) Type I, showing an intact circle;(2) Type II, anterior part incompletely; (3) Type III, posterior part incompletely; (4) Type IV, both anterior and posterior parts incompletely. And analyze the relation between the circle of Willis and cerebral ischemic disease in those 4 groups. Results In all 231 cases, circle of Willis Type I, II, III and IV was found in 7.8%, 4.3%, 38.5%and 49.4%, respectively. The frequency of Type I and III in TIA group were more than these in CIgroup. The frequency of the anterior communicating artery (ACoA) segment in TIA group were more than CI group (χ2=10.832,P=0.001). The patients with abnormal perfusion area had most rate of Willis circle Type IV (60.33%), the rates of Type I, II, III were less than normal perfusion group (χ2=12.356,P=0.006). Conclusion Our study suggests that the potential of the primary collateral circulation is ultimately determined by the anatomic variability of Willis circle. ACoA may play a compensatory role when ICVD occurred. Perfusion abnormality in patients with ICVD was associated with the incomplete collateral circulation of Willis circle.