椎动脉优势与后循环梗死的相关性研究

目的探讨椎动脉优势（VAD）与后循环梗死发生率的相关性及VAD病人合并后循环梗死的危险因素。方法选取急性脑梗死病人286例，分为前循环梗死组（ACI组）178例和后循环梗死组（PCI组）98例，比较2组病人VAD发生率、发生侧及相关缺血性脑血管病危险因素指标；对PCI组进行梗死部位分类，比较VAD与非VAD病人不同分区后循环梗死发生率；分析伴有VAD的后循环梗死病人两侧椎动脉直径差与NHISS评分的相关性。结果ACI组和PCIS组病人年龄、性别及各常见缺血性脑血管病危险因素差异均无统计学意义（P>0.05），2组VAD发生率差异有统计学意义（P<0.01），VAD发生侧别差异无统计学意义（P>0.05）。PCI组病人中，VAD病人的小脑后下动脉供血区及基底动脉供血区梗死发生率均高于非VAD病人（P<0.01和P<0.05）。PCI组中伴VAD病人的两侧椎动脉直径差与NHISS评分呈明显正相关关系（r=0.466，P<0.01）。结论与其他常见脑血管病危险因素共存时，VAD可被认为是后循环梗死的一个危险因素；VAD病人更易发生后循环小脑后下动脉供血区及基底动脉供血区梗死，且双侧椎动脉直径差异越大，预后相对越差。

Study on the correlation between vertebral artery dominance and posterior circulation infarction

ObjectiveTo investigate the correlation between vertebral artery dominance(VAD) and incidence rate of posterior circulation infarction(PCI), and risk factors of VAD patients complicated with PCI.MethodsTwo hundred and eighty-six patients with acute cerebral infarction were divided into the anterior circulation infarction(ACI) group(178 cases) and posterior circulation infarction(PCI) group(98 cases).The incidence rate and occurrence side of VAD, and risk factors of ischemic cerebrovascular disease were compared between two groups.The infarction sites of PCI group were classified, and the incidence rate of PCI of different areas was compared between VAD and non-VAD patients.The correlation between bilateral vertebral artery diameter difference and NHISS score in posterior circulation infarction patients with VAD were analyzed.ResultsThe differences of the age, gender and risk factors of common ischemic cerebrovascular disease were not statistically significant(P>0.05), the difference of the incidence rate of VAD between two groups was statistically significant(P<0.01), and the difference of the occurrence side of VAD was not statistically significant(P>0.05).In PCI group, the incidence rates of the infarction of posterior inferior cerebellar artery supply area and basilar artery supply region in VAD patients were higher than those in non-VAD patients(P<0.01 and P<0.05).Among the PCIS patients complicated with VAD, the diameter difference of bilateral vertebral artery was positively correlated with NHISS score(r=0.466, P<0.01).ConclusionsWhen coexisting with other common cerebrovascular disease risk factors, VAD can be considered as a risk factor for PCI.Patients with VAD are more prone to infarction in the blood supply area of posterior inferior cerebellar artery and basilar artery.The greater the difference of bilateral vertebral artery diameter is, the worse the prognosis is.