本文選題：椎基底動脈擴張延長癥 + 腦卒中�。� 參考：《浙江大學》2014年碩士論文

【摘要】：背景和目的： 椎基底動脈延長擴張癥(vertebrobasilar dolichoectasia,VBD)是目前尚處于臨床研究和探索階段的一種特殊的腦血管變異性疾病。隨著醫(yī)學影像學的發(fā)展,人們對該疾病的認識逐漸增多。本文研究的目的是分析椎基底動脈延長擴張癥的影像學表現(xiàn),以及與腦卒中主要臨床資料的關(guān)系,為臨床早期診斷及早期治療提供參考依據(jù)。 方法： 回顧性分析2012年12月至2013年5月在浙江大學醫(yī)學院附屬第二醫(yī)院神經(jīng)內(nèi)科住院的腦卒中患者,經(jīng)影像學檢查確診,均符合第四屆全國腦血管疾病診斷標準,排除腦實質(zhì)及其他器質(zhì)性疾病。記錄患者的臨床資料(年齡、性別、煙酒嗜好、高血壓、糖尿病、高脂血癥、肥胖、冠心病、既往腦卒中病史)、通過頭顱CT、頭顱MRI或頭顱MRA檢查,從影像學表現(xiàn)(具體病變部位、椎基底動脈管徑大小、分叉高度、偏移程度)上進行VBD判斷。依據(jù)VBD的診斷標準[2-4]將入選患者分為VBD組和非VBD組。所有的數(shù)據(jù)資料使用統(tǒng)計軟件SPSS17.0進行分析。 結(jié)果： 1.入選病例共計772例,腦梗死患者558例,腦出血患者214例。VBD患者45例,占同期急性腦卒中患者的5.8%,其中伴有VBD的腦梗死患者33例,占腦梗死病例5.9%,伴有VBD的腦出血患者12例,占腦出血病例5.6%。 2.共有45例VBD患者,727例非VBD患者,對VBD組與非VBD組臨床資料比較,兩組發(fā)現(xiàn)男性(χ2=3.875,P0.05)、肥胖(x2=5.243,P0.05)、吸煙史(x2=4.213,P0.05)有統(tǒng)計學差異,而年齡(t=1.245,P0.05)、高血壓(x2=0.274,P0.05)、糖尿病(χ2=0.966,P0.05)、高脂血癥(χ2=0.974,P0.05)、冠心病史(χ2=0.184,P0.05)、腦卒中史(χ2=0.012,P0.05)無統(tǒng)計學差異。 3.45例VBD患者,根據(jù)影像學檢查,33例VBD伴腦梗死患者基底動脈直徑平均為5.04±0.27mm,椎動脈直徑平均為4.55±0.16mm,基底動脈分叉高度評級平均為1.45±0.56,基底動脈水平移位評級平均為1.33±0.48,而12例VBD伴腦出血患者基底動脈直徑平均為5.13±1.00mm,椎動脈直徑平均為4.48±0.40mm,基底動脈分叉高度評級平均為2.08±0.51,基底動脈水平移位評級平均為1.25±0.45。VBD患者腦出血組基底動脈分叉高度明顯高于腦梗死組(P0.05)。 4.伴VBD腦梗死組與腔隙性梗死及腦干梗死密切相關(guān),伴VBD腦出血組與腦干出血密切相關(guān),其臨床表現(xiàn)與梗死或出血部位有關(guān)。 結(jié)論： 1.VBD在腦梗死與腦出血中發(fā)病率差別不大。 2.VBD腦卒中的發(fā)生與男性,吸煙及肥胖密切相關(guān)。 3.基底動脈分叉高度與VBD腦出血的發(fā)生密切相關(guān)。 4.多種影像學檢查手段可提高VBD的臨床診斷率。
[Abstract]:Background and purpose: Vertebrobasilar dolichoectasia VBDD (vertebrobasilar dolichoectasia VBDD) is a special cerebrovascular variability disease which is still in the stage of clinical research and exploration. With the development of medical imaging, people's understanding of the disease is gradually increasing. The purpose of this study is to analyze the imaging features of vertebrobasilar artery dilatation and its relationship with the main clinical data of stroke, and to provide reference for early diagnosis and treatment of vertebrobasilar artery dilatation. Methods: From December 2012 to May 2013, the stroke patients hospitalized in the Department of Neurology, second affiliated Hospital of Zhejiang University Medical College, who were diagnosed by imaging examination, met the diagnostic criteria of the fourth National Cerebrovascular Disease. Exclude brain parenchyma and other organic diseases. Clinical data (age, sex, smoking and alcohol addiction, hypertension, diabetes, hyperlipidemia, obesity, coronary heart disease, past stroke history) were recorded. VBD was performed on imaging findings (location of lesion, diameter of vertebrobasilar artery, height of bifurcation, degree of deviation). Patients were divided into VBD group and non-VBD group according to the diagnostic criteria of VBD [2-4]. All data are analyzed using statistical software SPSS17.0. Results: 1. There were 772 patients with cerebral infarction, 558 patients with cerebral infarction and 45 patients with cerebral hemorrhage, accounting for 5.8% of the acute stroke patients in the same period. Among them, 33 cases were cerebral infarction patients with VBD, accounting for 5.9% of cerebral infarction cases, and 12 cases were cerebral hemorrhage patients with VBD. Accounting for 5.6% of cerebral hemorrhage. 2. There were 45 patients with VBD and 727 patients with non-VBD. There was a significant difference between the two groups in the clinical data of VBD group and non-VBD group (蠂 2 + 3.875% P 0.05, obesity 5.243% P 0.05, smoking history 24. 213% P 0.05), and there was a significant difference between the two groups in the clinical data of VBD group and non-VBD group (蠂 2 + 3.875%, P 0.05, P 0.05). However, there was no significant difference in age, hypertension, diabetes, hyperlipidemia, coronary heart disease (蠂 2, 0.184, P 0.05, 蠂 2, 0.184, P 0.05, 蠂 20.012, P 0.05), diabetes (蠂 2, 0.966, P 0.05, 蠂 2, 0.974, P 0.05, 蠂 2, 0.184, P 0.05, 蠂 2, 0. 012, P 0. 05, 蠂 2. 012, P 0. 05, 蠂 2, P 0. 05, 蠂 2, 0. 184, P 0. 05, 蠂 2 = 0. 184, P 0. 05). 3.45 patients with VBD, The average diameter of basilar artery, vertebral artery, basilar artery and basilar artery were 5.04 鹵0.27 mm, 4.55 鹵0.16 mm, 1.45 鹵0.56 and 1.33 鹵0.48 in 33 VBD patients with cerebral infarction according to imaging examination. The average diameter of basilar artery, vertebral artery and basilar artery were 5.13 鹵1.00mm, 4.48 鹵0.40mm and 2.08 鹵0.51mm, respectively. The average horizontal transposition grade of basilar artery in patients with cerebral hemorrhage was significantly higher than that in patients with cerebral infarction (P 0.05). 4. VBD cerebral infarction group was closely related to lacunar infarction and brainstem infarction, and VBD cerebral hemorrhage group was closely related to brainstem hemorrhage, and its clinical manifestation was related to infarct or location of hemorrhage. Conclusion: There was no significant difference in the incidence of 1.VBD between cerebral infarction and cerebral hemorrhage. The incidence of 2.VBD stroke is closely related to men, smoking and obesity. 3. The height of basilar artery bifurcation is closely related to the occurrence of VBD intracerebral hemorrhage. 4. A variety of imaging methods can improve the clinical diagnosis rate of VBD.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3

【共引文獻】

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