椎动脉与基底动脉粥样硬化所致双侧脑干梗死形态及分布的对比研究

目的探讨椎动脉与基底动脉粥样硬化病变所致双侧脑干梗死患者梗死灶的形态以及分们的特点。方法回顾性分析25例椎动脉或基底动脉粥样硬化所致双侧脑干梗死患者的影像学资料,根据血管病变部位分为椎动脉病变组（17例）和基底动脉病变组（8例）,比较两组患者的梗死灶的形态以及分布情况。结果①17例椎动脉病变患者均存在双侧椎动脉闭塞或严重狭窄（狭窄率为70％～99％）,其中8例为双侧椎动脉闭塞,9例为一侧椎动脉闭塞合并对侧椎动脉重度狭窄,病变部位多位于颅内;基底动脉病变组8例患者中,基底动脉闭塞3例,狭窄5例,其中3例为重度狭窄,2例狭窄率为50％～69％。②椎动脉病变组和基底动脉病变组双侧脑干多发性小梗死灶（〈1cm）分别为15例（15／17）和3例（3／8）,P〈0．05;单个大梗死灶（≥1cm）累及双侧脑十分别为3例（3／17）和6例（6／8）,P〈0．05;合并小脑梗死分别为13例（13／17）和2例（2／8）,P〈0．05。,结论椎动脉与基底动脉粥样硬化病变所致双侧脑干梗死梗死灶的形态以及分布有所不同,前者双侧脑干多发小梗死灶较多见,后者累及双侧脑干的大梗死灶多见。     

椎动脉优势与基底动脉弯曲的关系及其与脑梗死关系的研究进展

<正>双侧椎动脉通常不对称,当差异明显时就成为一侧椎动脉优势(VAD),其对基底动脉弯曲的形成及后循环脑梗死的影响仍处于探索阶段,本文对上述情况进行简要综述。1椎-基底动脉解剖以及VAD椎-基底动脉经桥脑腹侧的基底动脉沟向上至中脑底端、脑桥顶端,发出左右各一条大脑后动脉和小脑下前动脉,此后穿过硬脑膜,发出供应颈髓的脊髓前动脉、脊髓后动脉和供应部分小脑和第四脑室脉络丛的小脑后下动脉(PICA)。脑动脉     

延髓综合征与延髓梗死

延髓综合征是由延髓病变引起的以同侧脑神经受损症状合并对侧传导束型感觉障碍或偏瘫为特征的一组症候群.延髓梗死为延髓综合征的主要病因,熟悉延髓综合征将对延髓血管病的诊治有一定的帮助.     

椎动脉优势与基底动脉斑块特征间的关系:一项基于磁共振高分辨率血管壁成像技术的研究

目的 通过磁共振高分辨率血管壁成像(HR-VWI)技术,探究基底动脉血管形态以及动脉粥样硬化斑块特点在椎动脉优势(VAD)作用下的不同。方法 回顾性分析2019年9月至2022年9月哈尔滨医科大学附属第一医院磁共振科连续收治的基底动脉粥样硬化患者的临床及影像资料,根据VAD判定标准,将所有患者分为VAD组与非VAD组。收集患者的一般资料(性别、年龄、脑血管疾病危险因素等)和临床资料如实验室检查结果(同型半胱氨酸、血脂等)及影像学资料(MR检查资料),并根据HR-VWI图像分析基底动脉斑块特点,确定斑块的横向分布(包括腹侧壁、背侧壁、侧壁)以及纵向分布(远端、近端)。获得基底动脉最大管腔狭窄层面和参考层面的短轴横断面图像,测量感兴趣区(狭窄层和参考层)的管壁面积、管腔面积及血管面积,并根据公式计算狭窄程度、重构指数等,分析两组患者间临床资料及基底动脉形态学特征、斑块特征是否存在差异。结果 共纳入基底动脉粥样硬化患者71例,其中VAD组51例,非VAD组20例。与非VAD组比较,VAD组年龄更大[(62±12)岁比(56±16)岁,t=2.243,P=0.027],男性患者比例更高[74....     

基底动脉弯曲与脑干梗死患者早期预后不良的相关性研究

目的 探讨基底动脉弯曲与脑干梗死患者早期预后不良的关系。方法 回顾性纳入2020年4月至2022年5月常州市第二人民医院神经内科收治的脑干梗死患者171例,根据患者入院72 h内扩展版美国国立卫生研究院卒中量表(e-NIHSS)评分是否较入院时增加≥2分,分为预后不良组46例与预后良好组125例。所有患者均完成头颅MRI检查和CT血管造影(CTA)检查,收集入组患者的相关基线资料和入院e-NIHSS评分等。比较2组患者的基线临床资料及脑干梗死部位等,评估脑干梗死患者早期预后不良的预测因素。结果 2组高血压、入院e-NIHSS评分、椎动脉优势和基底动脉弯曲指数比较,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,高血压(OR=3.498,95%CI:1.085～11.271,P=0.036)、入院e-NIHSS评分(OR=1.217,95%CI:1.020～1.453,P=0.029)和基底动脉弯曲指数(OR=1.317,95%CI:1.159～1.496,P=0.001)是脑干梗死患者早期预后不良的独立预测因素。ROC曲线分析发现,基底动...     

基底动脉高分辨率MRI在孤立性脑桥梗死患者中的应用

孤立性脑桥梗死(isolated pontine infarction, IPI)是急性脑干梗死的主要类型。由于高分辨率MRI的应用, 近年来对IPI病因的研究热度逐渐升高。文章综述了IPI的基底动脉斑块特征以及疾病进展机制的最新研究进展, 旨在为IPI的病因研究提供参考。     

脑干腔隙性梗死的临床分析

目的 分析脑干腔隙性梗死的临床特点.方法 对47例脑干腔隙性梗死患者的危险因素、临床表现、影像学以及预后进行分析.结果 脑干腔隙性梗死的危险因素与其他腔隙性脑梗死相同;脑干腔隙性梗死的好发部位多在脑桥;其临床表现复杂多样化,缺乏典型的脑干定位表现.结论 单纯脑干腔隙性梗死诊断较困难,需要借助磁共振成像(MRI)诊断.     

预后良好的脑干梗死患者原因分析

脑干梗死指局部脑干组织坏死,在脑梗死中极为少见.随着医学科技的飞速发展和不断进步,磁共振成像（MRI）在临床得到了广泛的应用,从而显著提升了对脑干梗死的确诊率,但发生脑干梗死的病因各异,神经解剖结构损害部位不同,其临床症状复杂多样,轻重不一,给预后判断带来困难.现将近年来接诊的恢复良好19例患者的临床资料、治疗过程、磁共振表现进行回顾分析,以期提高预后判断的准确性.     

脑干梗死20例影像学分析

脑干梗死是指椎-基底动脉及其分支狭窄或闭塞,引起中脑、脑桥、延髓缺血性坏死、软化,约占脑梗死的21.2%[1].随着CT及MRI的广泛应用,对脑干梗死可获得迅速、准确的诊断.现对我科近2年来经CT或MRI证实的20例脑干梗死分析如下.     

永存舌下动脉合并脑干梗死一例

永存舌下动脉(PHA)是第二常见的颈动脉-基底动脉吻合,此类患者常伴随后交通动脉发育不良或缺如,以及同侧、对侧或双侧椎动脉的发育不良,由于血管的异常吻合,会导致脑缺血症状和体征的复杂化,前循环的栓子可以导致前循环和后循环梗死.本院近期收治了1例PHA合并脑干梗死患者,表现为构音障碍、吞咽困难,经过抗血小板聚集及改善循环...     

慢性阻塞性肺疾病对冠状动脉粥样硬化性心脏病患者的影响

目的探讨慢性阻塞性肺疾病(COPD)对冠状动脉粥样硬化性心脏病(CHD)患者的影响。方法收集2012年8月至2018年3月于首都医科大学附属北京同仁医院内科住院的CHD患者共121例,其中61例合并COPD,进行横断面分析,比较两组之间冠状动脉造影结果、Gensini评分和高敏C反应蛋白(hs-CRP)的差异。结果 CHD合并COPD组患者的Gensini评分较单纯CHD组升高(120.90±90.68比65.27±50.38,t=4.162,P=0.000);CHD合并COPD组发生一支及以上心外膜血管完全或次全闭塞的比例较单纯CHD组高(44.3%比21.7%,χ~2=6.979,P=0.008),两组发生左主干+三支心外膜血管或三支心外膜血管病变的比例相当。CHD合并COPD组的hs-CRP较单纯CHD组高,但差异无统计学意义[(6.95±9.52)mg/L比(5.03±4.90)mg/L,t=1.392,P=0.166]。多因素logistic回归分析显示,COPD与一支及以上心外膜血管完全或次全闭塞独立相关(OR:2.838,95%CI:1.251～6.437,P=0.013)。结论 CHD合并COPD患者的冠状动脉狭窄程度更重,出现一支及以上血管完全或次全闭塞的比例更高。COPD对CHD的影响机制可能是全身炎症反应。     

Evaluation of pulmonary blood supply by multiplanar cine magnetic resonance imaging in patients with pulmonary atresia and severe pulmonary stenosis

The purpose of this study was to assess the capability of multiplanar cine magnetic resonance imaging (MRI) for evaluating pre- and post-operative pulmonary circulation in patients with pulmonary atresia and severe pulmonary stenosis. Seventy-three multiplanar cine MRIs were performed in 30 patients, aged 1 month to 7 years (mean age, 27 months). The morphology and size of the central pulmonary arteries (PA), source of the major aortopulmonary collateral arteries (MAPCA), patency of Blalock–Taussig (BT) shunt vessels, and the post-operative pulmonary circulation were assessed. The accuracy of cine MRI was compared with that of angiography in all patients. The PA was visualized to the first hilar branch in 21 patients, but not in 8 patients in whom the central PA was absent. On follow-up MRI, PA growth was measured, and the results showed excellent correlation with the results obtained by angiography. In 17 patients who had undergone 23 BT shunt operations, cine MRI correctly demonstrated all patient shunts and 5 of 6 stenotic lesions. Multiplanar cine MRI provided excellent detail of the peripheral PA in all patients, 7 of 8 peripheral pulmonary stenoses, 3 of 4 nonconfluent pulmonary arteries, and 2 of 3 PA obstructions. Although the sources of MAPCA were identified in 7 of 9 patients, the distal connection of the MAPCA was not detected in all patients. Seven patients were reexamined after pulmonary plasty; they exhibited normal pulmonary flow patterns. Multiplanar cine MRI provides high-resolution imaging of PA with dynamic visualization of flow and is an effective noninvasive technique for evaluating pre- and post-operative patients with pulmonary atresia and severe pulmonary stenosis.     

Effects of chronic obstructive pulmonary disease on coronary atherosclerosis

The chronic systemic inflammation and oxidative stress are important features in chronic obstructive pulmonary disease (COPD). Atherosclerosis is accepted as an inflammatory disease. Both local and systemic inflammation and oxidative stress negatively affect the atherosclerotic process. Metabolic alterations, systemic inflammation, and neurohormonal activation frequently occur in patients with COPD. However, the impact of COPD on intensity and severity of atherosclerosis and morphology of stenotic lesions in patients with established coronary artery disease by coronary angiography is unknown. Eighty-eight patients who were diagnosed with COPD disease were enrolled in the study. Eighty-two patients without any pulmonary disease were included in the control group. Coronary angiography and blood gases analysis were performed in all patients. Gensini score and Extent score were used to evaluate the intensity and severity of atherosclerosis. Lesion morphologies were defined in all patients. The mean number of affected coronary arteries was 2.5 ± 0.6 in the COPD group and 2.1 ± 0.7 in the control group (P = 0.004). The mean Extent score was 37 ± 16 in the COPD group and 23 ± 11 in the control group (P = 0.001). The Gensini score in the COPD group was significantly higher than that in the control group (respectively 10.9 ± 6.3 vs 6.6 ± 4.1, P = 0.01). The number of critical lesions, and type B and C lesions were higher in the COPD group. Multivariate analysis demonstrated that COPD was independently predictive for Gensini score (odds ratio 1.371; 95% confidence interval 1.682–9.228; P = 0.002) and Extent score (odds ratio 1.648; 95% confidence interval 2.023–13.339; P = 0.001). Severity and intensity of atherosclerosis increases in COPD and atherosclerotic lesions have worse morphological properties in COPD.     

老年慢性肺原性心脏病合并冠心病临床分析

目的：探讨老年慢性肺心病合并冠心病的的临床特点。方法：回顾分析福建省老年医院2002年1月至2006年12月期间82例老年慢性肺心病合并冠心病患者（A组）和195例老年单纯慢性肺心病患者（B组）的临床资料，比较分析两组患者的临床特点。结果：两组比较是易患因素高血压、糖尿病和肥胖比例有显著差别（P〈0．05），临床表现陈旧性心肌梗塞史、完全性左束枝传导阻滞（LBBB）、心界向左或向左下扩大、持续缺血的ST—T改变、Ⅱ～Ⅲ度房室传导阻滞、电轴右偏和重度右心衰竭有显著差别（P〈0．05）。结论：慢性肺心病患者若有陈旧性心肌梗塞史、高血压、糖尿病、肥胖或LBBB、心界向左或左下扩大应考虑合并冠心病。     

Iodine-123 metaiodobenzylguanidine scintigraphic assessment of pulmonary vascular status in patients with chronic obstructive pulmonary disease

Background and objective: Lung uptake of iodine‐123 metaiodobenzylguanidine (¹²³I‐MIBG) is used as an indicator of pulmonary endothelial function. Decreased lung uptake of ¹²³I‐MIBG has been demonstrated in patients with COPD as compared with normal subjects. The present study was performed to examine the relationship between lung uptake of ¹²³I‐MIBG and pulmonary artery pressure (Ppa) at rest and during exercise, in patients with COPD. Methods: ¹²³I‐MIBG scintigraphy was performed in 19 patients with COPD. Anterior planar images were acquired 15 min after the injection of ¹²³I‐MIBG, and the total lung to upper mediastinum ratio (LMR) was calculated for both lungs. Right heart catheters were used to monitor Ppa continuously at rest and during exercise. Exercise was performed on an electrically braked bicycle ergometer at a constant workload of 25 W for 3 min. Results: In COPD patients the LMR were not correlated with the pulmonary function parameters measured before exercise, including FEV₁, PaO₂, DL_CO, or Ppa at rest. However, the percentage increase in Ppa during exercise was significantly correlated with LMR. Conclusions: Evaluation of the kinetics of lung uptake of ¹²³I‐MIBG may be a novel scintigraphic tool for the assessment of exercise‐induced pulmonary hypertension in patients with COPD.     

Magnetic resonance imaging of peripheral vascular disease. The state of the artery

Peripheral vascular disease is a term often used to describe the manifestation of atherosclerosis below the bifurcation of the abdominal aorta. Peripheral atherosclerosis is a major cause of morbidity in the developed countries and 2% of adults in late middle age have intermittent claudication, which is severe enough in some patients to warrant hospital admission. The disease produces problems either by reducing blood flow or by the release of emboli from ulcerated plaques. The morphology and composition of arterial segments containing atheroma is of considerable importance. Plaques of different morphology have different effects on the arterial wall, such as the potential for thrombosis and the effect of arterial spasm. The lipid content may also affect the propensity for fissuring, ulceration, and thrombosis. In addition to discrete atherotic lesions, a localized and generalized sclerosis occurs. Sclerosis, or stiffness, can be demonstrated in experimental disease in animals and in man, and regression leads to reduced stiffness. Magnetic resonance imaging promises a comprehensive assessment of peripheral atherosclerosis noninvasively and without the use of ionizing radiation. Atheroma can be imaged directly, its size can be measured, its shape can be described, its lipid content can be assessed, and its effects upon vascular hemodynamics can be studied. In addition, arterial compliance, pulse wave velocity, and the pattern of flow within the vessel can be studied. It is thus a potential tool not only for the detection of disease but also for studying its natural history, risk factors, and the effects of pharmacological or surgical interventions.     

慢性阻塞性肺疾病患者合并冠心病的危险因素分析

目的 进一步探讨慢性阻塞性肺疾病(COPD)患者合并冠心病(CHD)的危险因素.方法 选取2019年1月～2020年1月在徐州医科大学附属医院因COPD急性加重住院治疗的120例患者为研究对象,按是否合并CHD进行分组,收集2组患者的人口学资料、临床及实验室相关数据.采用SPSS 22.0统计软件进行数据分析.根据数据...