CAJ | 학술논문

目的分析脑动脉夹层住院患者的临床特点，促进对脑动脉夹层的早期识别、早期诊断和治疗。方法回顾性分析首都医科大学附属北京天坛医院神经内科及神经介入科2014年12月～2015年4月经全脑血管造影或高分辨磁共振成像诊断的脑动脉夹层患者的临床特点、影像学特点及治疗措施的情况。 　　结果共纳入70例脑动脉夹层患者。平均年龄（50.0±12.8）岁，男性52例（74%），女性18例（26%）。颈动脉颅外段夹层21例（30%），椎动脉段夹层30例（43%），基底动脉夹层15例（21%），大脑中动脉水平段夹层1例（1%），侧裂段夹层1例（1%）。大脑后动脉及锁骨下动脉夹层各1例（1%）。非蛛网膜下腔出血性头痛19例（27%），头晕3例（4%），颈痛11例（16%），缺血性卒中16例（23%），蛛网膜下腔出血5例（7%），短暂性脑缺血发作4例（6%），其中3例经检查后发现缺血性卒中，无症状者19例（27%）。1例同时存在头痛和颈痛。3例患者同时存在缺血性卒中和头痛，1例患者同时存在颈痛、短暂性脑缺血发作和缺血性卒中。动脉夹层的影像学特征主要表现为动脉局部瘤样扩张、内膜瓣、动脉壁内新月形高信号征等。接受抗栓治疗者9例（13%），单纯抗凝治疗2例（3%），支架辅助弹簧圈填塞17例（24%），单纯弹簧圈填塞5例（7%），单纯支架治疗11例（16%），抗凝结合支架治疗者1例（1%），没有治疗者23例（33%），死亡2例（3%）。 　　结论脑动脉夹层的患者临床症状表现形式不同，轻症者可无症状，或单纯头颈痛，重症者可表现为短暂性脑缺血发作、缺血性卒中或蛛网膜下腔出血，正确诊断和相应的治疗十分重要。
목적분석뇌동맥협층주원환자적림상특점，촉진대뇌동맥협층적조기식별、조기진단화치료。방법회고성분석수도의과대학부속북경천단의원신경내과급신경개입과2014년12월～2015년4월경전뇌혈관조영혹고분변자공진성상진단적뇌동맥협층환자적림상특점、영상학특점급치료조시적정황。 　　결과공납입70례뇌동맥협층환자。평균년령（50.0±12.8）세，남성52례（74%），녀성18례（26%）。경동맥로외단협층21례（30%），추동맥단협층30례（43%），기저동맥협층15례（21%），대뇌중동맥수평단협층1례（1%），측렬단협층1례（1%）。대뇌후동맥급쇄골하동맥협층각1례（1%）。비주망막하강출혈성두통19례（27%），두훈3례（4%），경통11례（16%），결혈성졸중16례（23%），주망막하강출혈5례（7%），단잠성뇌결혈발작4례（6%），기중3례경검사후발현결혈성졸중，무증상자19례（27%）。1례동시존재두통화경통。3례환자동시존재결혈성졸중화두통，1례환자동시존재경통、단잠성뇌결혈발작화결혈성졸중。동맥협층적영상학특정주요표현위동맥국부류양확장、내막판、동맥벽내신월형고신호정등。접수항전치료자9례（13%），단순항응치료2례（3%），지가보조탄황권전새17례（24%），단순탄황권전새5례（7%），단순지가치료11례（16%），항응결합지가치료자1례（1%），몰유치료자23례（33%），사망2례（3%）。 　　결론뇌동맥협층적환자림상증상표현형식불동，경증자가무증상，혹단순두경통，중증자가표현위단잠성뇌결혈발작、결혈성졸중혹주망막하강출혈，정학진단화상응적치료십분중요。
Objective To analyze the clinical characteristics of brain artery dissection and promote the early diagnosis and treatment. Methods The clinical, neuroimaging characteristic and treatment was retrospectively analyzed. Results Totally 70 patients were analyzed. The mean age was (50.0±12.8) years old. There were 52 (74%) males and 18 (26%) females. There were 21 (30%) patients had extracranial carotid dissection, 30 (43%) had vertebral artery dissection, 15 (21%) had basilar artery dissection. There was 1 (1%) patient had dissection at horizontal segment, lateral ifssure segment, post brain artery and subclavian artery respectively. Total 19 (27%) patients had headache, 3 (4%) had dizzness, 11 (16%) had neck pain. There were 16 (23%) patients had ischemic stroke, 5 (7%) patients had subarachnoid hemorrhage (SAH), 4 (6%) patients had transient ischemic attack (TIA) (3 patients had ischemic stroke diagnosed latterly). One of the patients had headache and neck pain at the same time. 3 patients had ischemic stroke and headache, 1 (1%) patient had TIA, neck pain, ischemic stroke at the same time. Imaging showed dilatation like aneurysm, intial lfap, crescent high signal in the artery wall. About 9 (13%) patients had antithrombus therapy, 2 (3%) had anticoagulant therapy, 17 (24%) had coil therapy with stent assistant, 11 (16%) had stent therapy, 1 (1%) had anticoagulant and stent therapy. Total 23 (33%) patients had no therapy and 2 (3%) were dead. Conclusion Patients with brain artery dissection may have no symptom, or headache and neck pain, or TIA, ischemic stroke or SAH. Early diagnosis and suitable treatment are very important.