Graves病合并煙霧病1例報告并臨床特征分析
發(fā)布時間：2018-11-20 12:36
【摘要】：背景：Graves病煙霧病是一種慢性進(jìn)展的腦血管疾病,病因不明,特點是雙側(cè)頸內(nèi)動脈遠(yuǎn)端嚴(yán)重狹窄或閉塞,同時伴隨腦底部和軟腦膜煙霧狀毛細(xì)血管網(wǎng)形成。Graves病是一種自身免疫疾病,以體內(nèi)過多的甲狀腺激素為特點。近幾年國內(nèi)外僅有少量關(guān)于Graves病合并煙霧病的報道,認(rèn)為兩者之間可能存在一定關(guān)系,但尚未明確。 目的：研究Graves并合并煙霧病的發(fā)病機制及二者關(guān)系,探討其臨床特點及治療策略。 方法：對1例確診為Graves病合并煙霧病患者的臨床資料進(jìn)行報道,并檢索中國知網(wǎng)、Pubmed、萬方數(shù)據(jù)庫自1991年至今收錄發(fā)表的資料較完整的甲亢合并煙霧病的臨床病例報道和病例分析,進(jìn)行甲亢合并煙霧病的發(fā)病機制及臨床特征的探討。 結(jié)果：Graves病合并煙霧病的報道較少,由Kushima等于1991年首次報道二者合并,亞洲人發(fā)病率高于歐美,通過相關(guān)文獻(xiàn),總結(jié)如下：青年女性發(fā)病率明顯高于其他年齡性別的患者,有遺傳傾向,多于甲狀腺毒癥期間發(fā)作煙霧病,Graves病合并煙霧病的發(fā)病機制目前主要考慮有自身免疫反應(yīng)、血流動力學(xué)異常、遺傳因素、動脈粥樣硬化四個因素,但因研究報道較少,目前仍不能明確。顱腦影像學(xué)檢查腦梗死表現(xiàn)明顯多于腦出血,血管造影雙側(cè)明顯多余單側(cè),多伴煙霧狀血管網(wǎng),煙霧病的病情與甲狀腺功能明顯相關(guān),煙霧病發(fā)病多處在甲功亢進(jìn)狀態(tài),甲狀腺功能改善,腦卒中病情好轉(zhuǎn)。抗甲亢治療降低腦代謝,聯(lián)合神經(jīng)系統(tǒng)治療改善癥狀,腦膜顳淺動脈血管融通術(shù)可使顱外向顱內(nèi)增加血液代償,血管重建術(shù)可能是預(yù)防腦卒中的有效方法。 結(jié)論：Graves病與煙霧病的發(fā)病機制有一定聯(lián)系,前者直接影響煙霧病的病情變化,體內(nèi)甲狀腺素水平的突然變化可引起腦缺血性卒中,控制甲亢,煙霧病癥狀得到改善。對于腦底動脈閉塞的年輕患者,無論是否有甲亢癥狀,都有必要進(jìn)行甲狀腺功能檢測,同時行MRA或DSA協(xié)助早期診斷。
[Abstract]:Background: moyamoya disease is a chronic progressive cerebrovascular disease with unknown etiology characterized by severe stenosis or occlusion of the distal end of bilateral internal carotid artery. Graves's disease is an autoimmune disease characterized by excessive thyroid hormones. In recent years, there are only a few reports about Graves's disease combined with moyamoya disease at home and abroad. It is considered that there may be a certain relationship between the two diseases, but it is not clear. Objective: to study the pathogenesis and the relationship between Graves and moyamoya disease, and to explore its clinical features and treatment strategies. Methods: the clinical data of a case of Graves's disease complicated with moyamoya disease were reported and searched for Pubmed,. The clinical case report and case analysis of hyperthyroidism combined with moyamoya disease were published in Wanfang database from 1991 to present. The pathogenesis and clinical characteristics of hyperthyroidism combined with moyamoya disease were discussed. Results: there were few reports of Graves's disease associated with moyamoya disease. Kushima was the first to report the combination of the two diseases in 1991. The incidence rate of Asian people was higher than that of Europe and the United States. According to the relevant literature, the incidence rate of young women was significantly higher than that of patients of other age and sex. The pathogenesis of Graves's disease with moyamoya disease mainly includes autoimmune response, hemodynamic abnormality, genetic factors and atherosclerosis. However, due to the lack of research reports, it is still not clear. Craniocerebral imaging examination showed that cerebral infarction was obviously more than cerebral hemorrhage, bilateral angiography was obviously superfluous on one side, and most of them were accompanied with smog vascular network. The condition of moyamoya disease was significantly related to thyroid function, and moyamoya disease occurred in hyperthyroidism. Thyroid function improved and stroke improved. Antihyperthyroidism therapy can reduce brain metabolism, combined with nervous system therapy to improve symptoms. Superficial temporal artery fusion can increase blood compensation. Vascular reconstruction may be an effective method to prevent cerebral apoplexy. Conclusion: Graves's disease is related to the pathogenesis of moyamoya disease, the former directly affects the change of moyamoya disease, and the sudden change of thyroxine level in body can cause cerebral ischemic stroke, control hyperthyroidism and improve the symptoms of moyamoya disease. For young patients with basal cerebral artery occlusion, it is necessary to test thyroid function with or without hyperthyroidism and to perform MRA or DSA to facilitate early diagnosis.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R581.1;R743
本文編號：2344927
[Abstract]:Background: moyamoya disease is a chronic progressive cerebrovascular disease with unknown etiology characterized by severe stenosis or occlusion of the distal end of bilateral internal carotid artery. Graves's disease is an autoimmune disease characterized by excessive thyroid hormones. In recent years, there are only a few reports about Graves's disease combined with moyamoya disease at home and abroad. It is considered that there may be a certain relationship between the two diseases, but it is not clear. Objective: to study the pathogenesis and the relationship between Graves and moyamoya disease, and to explore its clinical features and treatment strategies. Methods: the clinical data of a case of Graves's disease complicated with moyamoya disease were reported and searched for Pubmed,. The clinical case report and case analysis of hyperthyroidism combined with moyamoya disease were published in Wanfang database from 1991 to present. The pathogenesis and clinical characteristics of hyperthyroidism combined with moyamoya disease were discussed. Results: there were few reports of Graves's disease associated with moyamoya disease. Kushima was the first to report the combination of the two diseases in 1991. The incidence rate of Asian people was higher than that of Europe and the United States. According to the relevant literature, the incidence rate of young women was significantly higher than that of patients of other age and sex. The pathogenesis of Graves's disease with moyamoya disease mainly includes autoimmune response, hemodynamic abnormality, genetic factors and atherosclerosis. However, due to the lack of research reports, it is still not clear. Craniocerebral imaging examination showed that cerebral infarction was obviously more than cerebral hemorrhage, bilateral angiography was obviously superfluous on one side, and most of them were accompanied with smog vascular network. The condition of moyamoya disease was significantly related to thyroid function, and moyamoya disease occurred in hyperthyroidism. Thyroid function improved and stroke improved. Antihyperthyroidism therapy can reduce brain metabolism, combined with nervous system therapy to improve symptoms. Superficial temporal artery fusion can increase blood compensation. Vascular reconstruction may be an effective method to prevent cerebral apoplexy. Conclusion: Graves's disease is related to the pathogenesis of moyamoya disease, the former directly affects the change of moyamoya disease, and the sudden change of thyroxine level in body can cause cerebral ischemic stroke, control hyperthyroidism and improve the symptoms of moyamoya disease. For young patients with basal cerebral artery occlusion, it is necessary to test thyroid function with or without hyperthyroidism and to perform MRA or DSA to facilitate early diagnosis.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R581.1;R743
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