本文選題：成人煙霧病　切入點：流行病學　出處：《天津醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的 分析成人煙霧病患者的流行病學、病理、臨床表現、影像學特征、治療方法以及轉歸等,旨在加深對該病的認識,為臨床診治提供參考依據。 方法 1.回顧性收集2003年4月～2013年4月間在天津市環(huán)湖醫(yī)院住院治療的57例成人煙霧病患者的臨床和影像學資料。 2.將發(fā)生缺血性腦血管病事件的患者歸為缺血組,將發(fā)生出血性腦血管病事件的患者歸為出血組。比較兩組患者的流行病學、臨床表現、病變血管、腦動脈瘤、出院轉歸情況等差異。 3.總結成人煙霧病患者頭顱CT、MRI表現,并分析頭顱MRA對該病的診斷價值。 4.評估腦血管重建術對成人煙霧病的治療效果。 5.全部數據采用SPSS19.0統計軟件進行處理。所有統計均采用雙側檢驗,統計推斷的檢驗水準為a=0.05,P0.05時認為差異有統計學意義。 結果 1.患者平均36.42±10.85歲,男女比例1：1.48,來自天津及周邊地區(qū),均為漢族,0人有家族史。缺血組和出血組平均年齡、年齡組成、性別、發(fā)病季節(jié)差異無統計學意義。缺血組吸煙比例高于出血組,差異有統計學意義。5.3%患者存在特殊病史,10.5%患者發(fā)病前有明顯誘因。 2.病理顯示：1例顳淺動脈管壁增厚,管腔狹窄,局部鈣鹽沉積,免疫組化CD34、抗平滑肌抗體陽性；1例硬腦膜小動脈內膜部分增生,部分剝脫,小靜脈擴張,局部出血；1例硬腦膜及少許軟腦膜輕度增厚。 3.患者最常見的臨床表現依次為頭痛頭暈、肢體運動障礙、視覺異常、肢體感覺異常,語言障礙、意識障礙。缺血組視覺異常、肢體運動障礙比例高于出血組,出血組頭痛頭暈、意識障礙比例高于缺血組,出血組入院NIHSS評分和住院期間最高NIHSS評分高于缺血組,差異有統計學意義。 4.6例患者風濕免疫全項均大致正常。 5.缺血組30.4%患者存在腦萎縮,梗死灶93.1%患者位于一側大腦半球,37.9%患者累及后循環(huán),69.0%患者為多發(fā)性斑點狀,不符合常規(guī)血管分布。出血組13.0%患者存在腦萎縮,21.7%患者存在多發(fā)腔隙性梗死灶伴軟化灶,出血部位56.5%患者累及腦實質,52.2%患者累及腦室,30.4%患者累及蛛網膜下腔。 6.缺血組大腦后動脈狹窄(或閉塞)比例高于出血組,差異有統計學意義,兩組大腦后動脈分期差異亦有統計學意義。兩組Suzuki分期差異無統計學意義。出血組腦動脈瘤比例高于缺血組,差異有統計學意義,且腦動脈瘤是成人出血型煙霧病的危險因素。 7.MRA診斷頸內動脈C1段、大腦前動脈A1段、大腦中動脈M1段、大腦后動脈P1段狹窄(或閉塞)的陽性預測值為55.8%-90.1%,陰性預測值為45.9%-88.5%,靈敏度為75.3%-97.2%,特異度為40.0%-76.8%,正確率為78.6%-93.8%。MRA1級患者Suzuki分期表現為Ⅰ期、Ⅱ期,MRA2級患者對應Suzuki分期Ⅱ期、Ⅲ期、Ⅳ期,MRA3級患者對應Suzuki分期Ⅱ期、Ⅳ期,MRA4級患者對應Suzuki分期V期、Ⅵ期。在代償血管顯影方面MRA視脈絡膜后動脈、胼周后動脈、眼動脈與DSA差別不大,其他小血管常顯示不清。 8.缺血組和出血組出院NIHSS評分差異無統計學意義�；颊咝心X血管重建術后6月mRS評分低于術前,差異有統計學意義�；颊咝g后數天～20月復查血管影像顯示均已建立頸外動脈系統至頸內動脈系統交通支。 結論 1.本資料顯示成人煙霧病好發(fā)于青中年患者,男女比例1：1.48； 2.腦動脈瘤是成人出血型煙霧病的危險因素； 3.成人煙霧病常見臨床表現依次為頭痛頭暈、肢體運動障礙、視覺異常、肢體感覺異常,缺血型患者更易出現肢體運動障礙、視覺異常； 4.成人煙霧病患者梗死灶常呈多發(fā)性,不符合常規(guī)血管分布,出血易累及側腦室,診斷依賴血管影像學檢查,除DSA外,MRA亦能作為診斷標準； 5.除一般內科治療外,患者可考慮行腦血管重建術。
[Abstract]:objective
Objective to analyze the epidemiology, pathology, clinical manifestations, imaging features, treatment and outcome of adult moyamoya disease, so as to deepen our understanding of the disease and provide a reference for clinical diagnosis and treatment.
Method
1. the clinical and imaging data of 57 adult moyamoya patients hospitalized in Tianjin Huanhu Hospital from April 2003 to April 2013 were retrospectively reviewed.
2., patients with ischemic cerebrovascular disease were classified as ischemic group. Patients with hemorrhagic cerebrovascular disease were classified as bleeding group. The epidemiology, clinical manifestations, pathological vessels, cerebral aneurysms and discharge outcomes of two groups were compared.
3. to summarize the CT and MRI manifestations of the head of adult moyamoya disease, and to analyze the diagnostic value of skull MRA for the disease.
4. to evaluate the therapeutic effect of cerebral vascular reconstruction in adult moyamoya disease.
5., all data were processed by SPSS19.0 statistical software. All the statistics were tested by bilateral test. The statistical inference level was a=0.05, P0.05. The difference was statistically significant.
Result
1. patients with an average of 36.42 + 10.85 years, the proportion of male and female 1:1.48, from Tianjin and the surrounding areas, are Han nationality, 0 people with a family history of ischemic group and the hemorrhage group. The average age, age, gender, no significant seasonal differences. The smoking rate is higher than the ischemia group hemorrhage group, the difference was statistically significant in patients with.5.3% special history, 10.5% have obvious incentives before the onset of disease.
2. pathological examination showed: 1 cases of superficial temporal artery wall thickening, stenosis, partial deposition of calcium salt, immunohistochemical CD34, anti smooth muscle antibody positive; 1 cases of dural arterial intimal hyperplasia, partial exfoliation, small vein dilatation, local hemorrhage; 1 cases of dural and pial a mild thickening.
The most common clinical manifestations of 3. patients were headache and dizziness, limb movement disorder, abnormal vision, acroparesthesia, language disorder, disorder of consciousness. In ischemic group, abnormal vision, limb movement disorder is higher than the proportion of bleeding group, hemorrhage group headache, disturbance of consciousness was higher than that of ischemic group, hemorrhage group NIHSS score on admission and during hospitalization, the highest NIHSS the score is higher than that of ischemic group, the difference was statistically significant.
All 4.6 cases of rheumatic immunization were generally normal.
The 5. group of 30.4% patients with ischemic cerebral atrophy, 93.1% patients with cerebral infarction located in cerebral hemisphere, 37.9% patients with posterior circulation, 69% patients with multiple spots, do not conform to the normal distribution. The vascular hemorrhage group 13% patients had cerebral atrophy, 21.7% patients with lacunar infarcts with encephalomalacia, bleeding in 56.5% patients involving the brain parenchyma, 52.2% patients involving 30.4% patients with ventricle and subarachnoid space.
6. ischemia group (posterior cerebral artery stenosis or occlusion) is higher than the hemorrhage group, the difference was statistically significant, the two group stage posterior cerebral artery. There was significant difference between the two groups had no statistically significant difference in bleeding group. Suzuki staging of cerebral aneurysms is higher than the proportion of the ischemia group, the difference was statistically significant, and the cerebral aneurysm is adult moyamoya disease risk factors.
7.MRA diagnosis of C1 segment of internal carotid artery, anterior cerebral artery A1 segment, M1 segment of middle cerebral artery, posterior cerebral artery P1 segment stenosis (or block) of the positive predictive value and negative predictive value of 55.8%-90.1%, 45.9%-88.5%, sensitivity is 75.3%-97.2%, the specificity of 40.0%-76.8% II, the correct rate is 78.6% -93.8%.MRA1 with Suzuki stage performance the first stage, patients with grade MRA2 corresponding to Suzuki stage II, III, IV, MRA3 with corresponding Suzuki stage II, stage IV patients with grade MRA4, corresponding to Suzuki stage V, stage VI. In developing the MRA optic compensatory vessels posterior choroidal artery pericallosal artery, ophthalmic artery had little difference DSA and other small vessels is often unclear.
8. ischemia group and bleeding group NIHSS score between the discharge was not statistically significant. Patients with cerebral revascularization after June mRS score lower than before, the difference was statistically significant. Postoperative days to 20 months of vascular image display have been established for the external carotid artery to internal carotid artery system traffic.
conclusion
1. the data showed that adult moyamoya disease was found in middle-aged and middle-aged patients with a ratio of 1:1.48 to men and women.
2. cerebral aneurysm is a risk factor for adult moyamoya disease.
3., the common clinical manifestations of adult moyamoya disease are headache, dizziness, limb movement disorder, visual abnormality, limb sensation abnormality, and patients with ischemic type are more likely to have limb movement disorders and abnormal vision.
4. adult patients with moyamoya disease often have multiple infarcts, which do not conform to routine blood vessel distribution. Bleeding is easy to involve the lateral ventricle. Diagnosis depends on vascular imaging. Besides DSA, MRA can also be used as a diagnostic standard.
5. in addition to general medical treatment, the patient may consider revascularization of the brain.

【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3

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