软脑膜侧支循环对症状性大脑中动脉
狭窄或闭塞患者卒中复发及死亡事件影响研究

摘要/Abstract

摘要：

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。

文章导读： 本研究对不同软脑膜动脉代偿情况的症状性大脑中动脉狭窄或闭塞患者1年预后进行研究，显示
有软脑膜动脉代偿的患者在卒中复发和总死亡率方面均低于无代偿的患者。

关键词: 大脑中动脉; 狭窄或闭塞; 侧支循环; 预后

Abstract:

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 influence 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 significant 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 significant differences in recurrent ischemic stroke, total events in double pathway LMA group; there was statistical significant 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.

Key words: Middle cerebral artery; Stenosis or occlusion; Collateral circulation; Prognosis

张幼林，冀瑞俊，王春娟，王拥军. 软脑膜侧支循环对症状性大脑中动脉
狭窄或闭塞患者卒中复发及死亡事件影响研究[J]. 中国卒中杂志, 2014, 9(11): 917-923.

ZHANG You-Lin, JI Rui-Jun, WANG Chun-Juan, WANG Yong-Jun.. Impact of Different Pathways about Leptomeningeal Anastomoses on the Prognosis of
Patients with Symptomatic Middle Cerebral Artery Stenosis or Occlusion[J]. Chinese Journal of Stroke, 2014, 9(11): 917-923.

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