CAJ | 학술논문

目的：探讨烟雾病合并Graves病的临床特征和颅内外血管重建术的效果。方法回顾性分析4例成人烟雾病合并Graves病患者的临床资料,女3例,男1例,平均年龄(32±7)岁。对4例患者在经药物治疗甲状腺功能正常后,均行颞浅动脉-大脑中动脉旁路移植术,观察手术疗效及随访结果。结果(1)3例表现为脑梗死,1例表现为频繁短暂性脑缺血发作。 DSA证实2例为单侧烟雾病,2例为双侧烟雾病；头部MRI均可见脑梗死灶。(2)药物治疗甲状腺功能正常后,3例烟雾病症状稳定,1例在术后1周内有高热、心率快等高代谢症状；血管重建术后随访6~18个月症状改善,1例良好,3例优秀,Graves病均无复发。复查头部MRI提示4例患者均无新发脑梗死灶, MR血管成像可见缺血灶区域脑沟内动脉充盈较术前明显改善,有2例可见患侧大脑中动脉M2~M3段逆行充盈。术后单光子发射计算机体层扫描脑灌注成像提示,手术侧缺血灶灌注较手术前明显改善。结论合并Graves病时烟雾病症状加重,表现为急性或慢性脑缺血症状。控制甲状腺功能亢进症状后,脑缺血症状多数能缓解。颞浅动脉-大脑中动脉旁路移植术能够建立有效的侧支循环,改善临床症状。
목적：탐토연무병합병Graves병적림상특정화로내외혈관중건술적효과。방법회고성분석4례성인연무병합병Graves병환자적림상자료,녀3례,남1례,평균년령(32±7)세。대4례환자재경약물치료갑상선공능정상후,균행섭천동맥-대뇌중동맥방로이식술,관찰수술료효급수방결과。결과(1)3례표현위뇌경사,1례표현위빈번단잠성뇌결혈발작。 DSA증실2례위단측연무병,2례위쌍측연무병；두부MRI균가견뇌경사조。(2)약물치료갑상선공능정상후,3례연무병증상은정,1례재술후1주내유고열、심솔쾌등고대사증상；혈관중건술후수방6~18개월증상개선,1례량호,3례우수,Graves병균무복발。복사두부MRI제시4례환자균무신발뇌경사조, MR혈관성상가견결혈조구역뇌구내동맥충영교술전명현개선,유2례가견환측대뇌중동맥M2~M3단역행충영。술후단광자발사계산궤체층소묘뇌관주성상제시,수술측결혈조관주교수술전명현개선。결론합병Graves병시연무병증상가중,표현위급성혹만성뇌결혈증상。공제갑상선공능항진증상후,뇌결혈증상다수능완해。섭천동맥-대뇌중동맥방로이식술능구건립유효적측지순배,개선림상증상。
Objective To investigate the clinical features of moyamoya disease complicated with Graves′disease and the efficacy of extra-and intra-cranial revascularization. Methods The clinical data of 4 patients with moyamoya disease complicated with Graves′disease were analyzed retrospectively. Among them,three were females and one was a male. Their mean age was 32 ± 7 years. After medical treatment, their thyroid function was normal. The patients were treated with superficial temporal artery-middle cerebral artery bypass grafting. Results (1) Three patients showed cerebral infarction and one showed frequent transient ischemic attack. DSA confirmed that 2 patients had unilateral moyamoya disease and 2 had bilateral moyamoya disease. Head MRI revealed brain infarcts. (2) The thyroid function was normal after drug treat-ment,the symptoms of moyamoya disease were stable in 3 cases. One patient had high metabolic symptoms, such as high fever and accelerated heart rate within one week after procedure. The patients were followedup for 6 to 18 months,one was good,3 were excellent,and there was no recurrence of Graves′disease. Postoperative head MRI revealed that the 4 patients did not have new brain infarcts. MRA showed that the arterial filling in cerebral sulci in the ischemic lesion areas was obviously improved compared with that before procedure. Retrograde filling of the ipsilateral middle cerebral artery M2-M3 segment was observed in 2 patients. Postoperative single photon emission computed tomography perfusion imaging revealed that the ischemic perfusion lesions on the operated sides were obviously improved compared with those before procedure. Conclusion When complicated with Graves′ disease,the symptoms of moyamoya disease will aggravate. It manifests as acute and chronic cerebral ischemia. After controlling the symptoms of hyperthyroidism,most cerebral ischemic symptoms can be alleviated. Superficial temporal artery-middle cerebral artery bypass grafting may establish an effective collateral circulation and improve the clinical symptoms.