CAJ | 학술논문

目的探讨成年烟雾病患者脑微出血的分布模式,及其与颅内血管形态学的联系.方法连续入选南京军区南京总医院2009年6月至2011年6月间首次经脑血管造影证实的成年烟雾病患者71例.对所有患者进行3.0T磁共振磁敏感成像检查并依照脑微出血病灶的分布区域分组.比较各组间包括年龄、性别、高血压、糖尿病、高脂血症、临床症状、起病时间以及血浆纤维蛋白原水平在内的基线危险因素,颅底烟雾血管铃木分级,后循环受累情况以及脉络膜前动脉-后交通动脉(AChA-PComA)分级等颅内血管形态学特点的关系.结果于23例患者的25侧半球中检出30处脑微出血灶,其分布以深部侧脑室旁白质为主,占70.0％(21/30).根据脑微出血解剖定位标准将所有142侧半球分为无脑微出血组、侧脑室旁深部白质脑微出血组及其他部位脑微出血组.单因素分析提示年龄及AChA-PComA极度延长扩张的比例有可能与脑微出血病灶分布模式有关.进一步进行多因素回归分析显示:相对无脑微出血半球,AChA-PComA的极度延长扩张是深部侧脑室旁白质区域脑微出血病灶的影响因素之一(OR =3.090,95％CI1.050 ～ 9.140,P=0.041),而与其他部位的脑微出血病灶无明显关联(OR=1.680,95％CI0.390 ～7.190,P=0.483).结论成年型烟雾病患者微出血病灶主要分布于深部侧脑室旁白质.这种特征性的分布模式可能与AChA-PComA的形态学变化有关.
목적 탐토성년연무병환자뇌미출혈적분포모식,급기여로내혈관형태학적련계.방법 련속입선남경군구남경총의원2009년6월지2011년6월간수차경뇌혈관조영증실적성년연무병환자71례.대소유환자진행3.0T자공진자민감성상검사병의조뇌미출혈병조적분포구역분조.비교각조간포괄년령、성별、고혈압、당뇨병、고지혈증、림상증상、기병시간이급혈장섬유단백원수평재내적기선위험인소,로저연무혈관령목분급,후순배수루정황이급맥락막전동맥-후교통동맥(AChA-PComA)분급등로내혈관형태학특점적관계.결과 우23례환자적25측반구중검출30처뇌미출혈조,기분포이심부측뇌실방백질위주,점70.0％(21/30).근거뇌미출혈해부정위표준장소유142측반구분위무뇌미출혈조、측뇌실방심부백질뇌미출혈조급기타부위뇌미출혈조.단인소분석제시년령급AChA-PComA겁도연장확장적비례유가능여뇌미출혈병조분포모식유관.진일보진행다인소회귀분석현시:상대무뇌미출혈반구,AChA-PComA적겁도연장확장시심부측뇌실방백질구역뇌미출혈병조적영향인소지일(OR =3.090,95％CI1.050 ～ 9.140,P=0.041),이여기타부위적뇌미출혈병조무명현관련(OR=1.680,95％CI0.390 ～7.190,P=0.483).결론 성년형연무병환자미출혈병조주요분포우심부측뇌실방백질.저충특정성적분포모식가능여AChA-PComA적형태학변화유관.
Objective To investigate the relationship between cerebral microbleeds (CMBs) and morphology of intracranial arteries in adult patients with moyamoya disease.Methods Seventy-one adult patients with first catheter-based angiography confirmed moyamoya disease in Jinling Hospital from June 2009 to June 2011 were enrolled in the present study.Clinical baseline parameters in each patient include age,gender,history of hypertension,diabetes,hyperlipidemia,clinical symptoms,onset time and plasma fibrinogen were collated.All of the patients underwent susceptibility-weighted imaging of 3.0 T magnetic resonance imaging system to detect the CMBs foci.According to the angiographies,the relationship between distribution patterns of CMBs and the morphology of intracranial arteries including Suzuki stages of moyamoya vessels at the base of brain,posterior circulation involvement as well as the stages of dilation and extension of anterior choroidal artery-posterior communicating arteries (AChA-PComA) were analyzed.Results A total of 30 CMBs foci in 25 hemispheres were separately found among 142 hemispheres of the entire 71 patients.Seventy percent (21/30) CMBs foci located in the regions of deep and periventricular white matter (DPWM).The total 142 hemispheres were categorized into non-CMBs group,DPWM-CMBs group and other region-CMBs group according to microbleeds anatomy rating scale.Univariate analysis suggested that age and the proportion of extremely dilation and extension of AChA-PComA might be potentially related to the distribution of CMBs.Further multinomial logistic regression analysis suggested that,extremely dilation and extension of AChA-PComA was an independent predictor for CMBs located in DPWM (OR =3.090,95％ CI1.050-9.140,P =0.041) rather than in other regions (OR =1.680,95％ CI 0.390-7.190,P =0.483),compared with non-CMBs group hemispheres . Conclusions CMBs in patients with moyamoya disease usually locate in the region of DPWM.This specific distribution patterns might be related to the morphology variation of AChA-PComA.