CAJ | 학술논문

目的：通过磁共振血管成像（magnetic resonance angiography，MRA）检查，研究不同途径的软脑膜动脉（leptomeningeal anastomoses，LMA）代偿对症状性大脑中动脉（middle cerebral artery，MCA）狭窄或闭塞患者1年内预后的影响。方法选取在首都医科大学附属北京天坛医院神经内科住院治疗的症状性MCA狭窄或闭塞患者，经过MRA评价LMA代偿情况分为大脑前动脉（anterior cerebral artery，ACA）途径代偿组、大脑后动脉（posterior cerebral artery，PCA）途径代偿组、双代偿途径组和无代偿组，据随访结果，对不同途径LMA代偿组预后对比，了解不同途径LMA代偿对患者预后的影响。结果随访1年中有17例缺血性卒中复发事件，复发率为6.83%。共6例患者死亡，死亡率为2.4%。在4组不同途径LMA代偿组间，缺血性卒中（χ2=7.824、P=0.0497）、总的不良事件（χ2=11.238、P=0.011）存在显著差异。其中无代偿组卒中复发高于双代偿途径组（P=0.022）。在总不良事件方面，无代偿组与双代偿途径组、无代偿组与ACA代偿途径组之间存在显著差异，P值分别为0.004和0.04。有代偿组在缺血性卒中、总事件等方面均低于无代偿组（P值分别为0.021和0.003）；两组间脑出血、全因死亡等方面无显著差异。结论良好的LMA可以有效减少症状性MCA狭窄或闭塞患者1年内缺血性卒中等不良事件的发生，但对脑出血及全因死亡无影响。
목적：통과자공진혈관성상（magnetic resonance angiography，MRA）검사，연구불동도경적연뇌막동맥（leptomeningeal anastomoses，LMA）대상대증상성대뇌중동맥（middle cerebral artery，MCA）협착혹폐새환자1년내예후적영향。방법선취재수도의과대학부속북경천단의원신경내과주원치료적증상성MCA협착혹폐새환자，경과MRA평개LMA대상정황분위대뇌전동맥（anterior cerebral artery，ACA）도경대상조、대뇌후동맥（posterior cerebral artery，PCA）도경대상조、쌍대상도경조화무대상조，거수방결과，대불동도경LMA대상조예후대비，료해불동도경LMA대상대환자예후적영향。결과수방1년중유17례결혈성졸중복발사건，복발솔위6.83%。공6례환자사망，사망솔위2.4%。재4조불동도경LMA대상조간，결혈성졸중（χ2=7.824、P=0.0497）、총적불량사건（χ2=11.238、P=0.011）존재현저차이。기중무대상조졸중복발고우쌍대상도경조（P=0.022）。재총불량사건방면，무대상조여쌍대상도경조、무대상조여ACA대상도경조지간존재현저차이，P치분별위0.004화0.04。유대상조재결혈성졸중、총사건등방면균저우무대상조（P치분별위0.021화0.003）；량조간뇌출혈、전인사망등방면무현저차이。결론량호적LMA가이유효감소증상성MCA협착혹폐새환자1년내결혈성졸중등불량사건적발생，단대뇌출혈급전인사망무영향。
Objective To investigate the effects of different pathways about leptomeningeal anastomoses (LMA) of patients with symptomatic middle cerebral artery (MCA) stenosis or occlusion on the prognosis by the examination of magnetic resonance angiography (MRA). Methods Patients with unilateral symptomatic MCA stenosis or occlusion, who received treatment at the Department of Neurology of Beijing Tiantan Hospital, Capital Medical University from January, 2009 to January, 2012, were selected, and their LMA status were ascertained with MRA evaluation. We aimed to explore the inlfuence of different LMA pathways on the patients' prognosis by combining the results of follow-up and comparing with end point events. Results There were statistically signiifcant differences among different LMA pathways in recurrent ischemic stroke, total events, but cerebral hemorrhage, all-cause death without difference. Pairwise comparisons in groups revealed:compared with no LMA group, there were statistically signiifcant differences in recurrent ischemic stroke, total events in double pathway LMA group; there was statistical signiifcant difference in total events between the group of anterior cerebral artery (ACA) pathway LMA and no LMA group. Conclusion This study showed that double pathway LMA demonstrated a protective role in patients with symptomatic MCA stenosis or occlusion, could effectively reduce the incidence of recurrent ischemic stroke, the overall adverse events within 1 year onset, but had no effects on the prognosis of cerebral hemorrhage and all-cause death. In terms of overall events.