CAJ | 학술논문

目的：探讨成人出血型烟雾病的出血类型与侧枝循环模式的关系。方法对同济大学附属同济医院2005年6月至2013年4月经DSA检查确诊的35例成人出血型烟雾病患者进行回顾性分析，根据头颅CT检查将颅内出血分为脑实质出血、脑室出血和蛛网膜下腔出血3种类型，其涉及的侧枝循环模式分为：第Ⅰ型前组：扩张的眼动脉分支筛前、后动脉及镰前动脉穿过颅底供应额叶皮质；第Ⅰ型后组：大脑后动脉皮层支→大脑前动脉和大脑中动脉皮层支；第Ⅱ型：由扩张和延长的脉络膜前动脉（anterior choroidal artery, AChA)和/或开放的后交通动脉(posterior communicating artery，PComA)→大脑后动脉→胼周后动脉和脉络膜后动脉→大脑前、中动脉深穿支；第Ⅲ型前组：脑膜中动脉和颞浅动脉→大脑前动脉和大脑中动脉供血区的代偿；第Ⅲ型后组：枕动脉→大脑后动脉供血区的代偿。分别使用Fisher′s确切概率法和交叉列联表比较三种出血类型组间和组内侧枝循环模式构成比的差异。结果该组出血型烟雾病患者存在2种或2种以上模式的侧枝循环占90.7%，不同出血部位组间侧枝循环代偿模式构成比有具有统计学差异(χ2=18.70，P=0.011)，即脑实质出血、脑室出血和蛛网膜下腔出血各亚组侧枝循环的优势模式分别为第Ⅲ型前组、第Ⅱ型和第I型前组。结论第Ⅲ型前组、第Ⅱ型和第I型前组侧支循环模式分别可能是导致成人出血型烟雾病脑实质出血、脑室出血和蛛网膜下腔出血的出血原因之一。
목적：탐토성인출혈형연무병적출혈류형여측지순배모식적관계。방법대동제대학부속동제의원2005년6월지2013년4월경DSA검사학진적35례성인출혈형연무병환자진행회고성분석，근거두로CT검사장로내출혈분위뇌실질출혈、뇌실출혈화주망막하강출혈3충류형，기섭급적측지순배모식분위：제Ⅰ형전조：확장적안동맥분지사전、후동맥급렴전동맥천과로저공응액협피질；제Ⅰ형후조：대뇌후동맥피층지→대뇌전동맥화대뇌중동맥피층지；제Ⅱ형：유확장화연장적맥락막전동맥（anterior choroidal artery, AChA)화/혹개방적후교통동맥(posterior communicating artery，PComA)→대뇌후동맥→변주후동맥화맥락막후동맥→대뇌전、중동맥심천지；제Ⅲ형전조：뇌막중동맥화섭천동맥→대뇌전동맥화대뇌중동맥공혈구적대상；제Ⅲ형후조：침동맥→대뇌후동맥공혈구적대상。분별사용Fisher′s학절개솔법화교차렬련표비교삼충출혈류형조간화조내측지순배모식구성비적차이。결과해조출혈형연무병환자존재2충혹2충이상모식적측지순배점90.7%，불동출혈부위조간측지순배대상모식구성비유구유통계학차이(χ2=18.70，P=0.011)，즉뇌실질출혈、뇌실출혈화주망막하강출혈각아조측지순배적우세모식분별위제Ⅲ형전조、제Ⅱ형화제I형전조。결론제Ⅲ형전조、제Ⅱ형화제I형전조측지순배모식분별가능시도치성인출혈형연무병뇌실질출혈、뇌실출혈화주망막하강출혈적출혈원인지일。
Objective Purpose The study was designed to investigate the relationship between hemorrhage types and patterns of the collateral circulation of hemorrhagic moyamoya disease in adults. Methods Thirty-five patients with adult DSA-confirmed hemorrhagic MMD in Tongji Hospital of Tongji University between June 2005 and November 2013, were retrospectively analyzed. The intracranial hemorrhage caused by MMD was classified into 3 types based on CT scan:cerebral hemorrhage, intraventricular hemorrhage, and subarachnoid hemorrhage (SHA). The patterns of collateral circula?tion were further divided into three types (TypeⅠ,ⅡandⅢ) and two groups (former group and latter group). The former group in TypeⅠ:The anterior falcial artery→the orbitofrontal artery , the anterior and posterior ethmoid arteries→supply the frontal cortex; The latter group in TypeⅠ: The cortical branches of the posterior cerebral artery(PCA)→the cortical branches of the middle ( MCA) and anterior cerebral arteries (ACA);TypeⅡ:The dilating and extensing anterior choroi? dal artery (AChA) and/or the posterior communicating artery (PComA)→PCA→the lateral posterior pericallosal and poste?rior choroidal arteries→the perforating branches of ACA and MCA;The former group in TypeⅢ:The middle meningeal artery and superficial temporal artery→the cortical branches of MCA and ACA;The latter group in TypeⅢ:The occipi?tal artery→PCA. The Fisher's Exact Test and the Contingency tables were respectively applied in the comparison of con?stituent ratio with patterns of collateral circulation in bleeding types. Results Up to 90.7% of patients had two or more than two patterns of Collateral circulation. In addition, there were significant differences in constituent ratio with patterns of the collateral circulation between different bleeding types (χ2=18.70,P=0.011). The dominant patterns of the collateral circulations of cerebral hemorrhage, intraventricular hemorrhage and SHA are the former group in the TypeⅢ, the typeⅡ and the former group in TypeⅠ, respectively. Conclusion The dominant pattern of the collateral circulations of the former group in the Type Ⅲ, the Type Ⅱ and the former group in TypeⅠmay be one of the causes of cerebral hemor?rhage, intraventricular hemorrhage and hemorrhagic moyamoya disease-related SHA in adults, respectively .