眩晕并椎动脉发育不良患者后循环梗死的规律及危险性分析

目的探讨椎动脉发育不良(vertebralartery dysplasia,VAH)在眩晕患者中的发生率及其相关后循环梗死的规律和危险性。方法连续入组245例眩晕患者(可疑为血管性),采用磁共振血管成像检查合并VAH情况,根据磁共振弥散加权成像是否出现后循环新鲜梗死灶分为梗死组和非梗死组,对相关血管危险因素进行单因素和多因素分析;并分析VAH合并后循环梗死的特点和规律。结果 VAH发生率26.1%(64/245);多因素分析显示VAH(OR=2.59,95%CI:1.07~6.27,P=0.035)、后循环血管狭窄(OR=6.04,95%CI=1.94~17.07,P=0.002)和糖尿病(OR=3.21,95%CI:1.36~7.57,P=0.008)是后循环梗死独立危险因素。VAH合并后循环梗死患者中,TOAST分型多为小动脉病变型(10/18);8例桥脑、丘脑和颞枕叶梗死发生在VAH对侧(8/11),4例小脑和延髓梗死发生在VAH同侧(4/6)。结论 VAH在可疑的血管性眩晕病人中较常见;VAH为后循环梗死的独立危险因素,其相关的梗死分布存在一定的规律性。

The risk analysis and regularity of posterior circulation infarction in vertigo patients with vertebral artery dysplasia

Objective To explore the prevalence of vertebral artery dysplasia (VAH)and its risk and regularity of poste-rior circulation infarction (PCI)in vertigo patients with VAH.Method We sequentially enrolled 245 patients suspected of vas-cular vertigo,detected by Magnetic Resonance Angiography (MRA)to judge if merged with VAH,who were divided into cere-bral infarction group and non-infarction group according to whether VAH formed fresh infarction or not measured by Diffu-sion-weighted Imaging (DWI).Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for PCI stroke.Finally,we analyzed the characteristics and regularity of PCI with VAH.Result The prevalence of VAH was 26.1% in vertigo patients.Multivariate logistic regression analysis showed that VAH (OR=2.59,95%CI:1.07-6. 27,P=0.035),stenosis of the posterior circulation (OR=6.04,95%CI:1.94-1 7.07,P=0.002)and diabetes mellitus (OR=3.21,95%CI:1.36-7.57,P=0.008)were independent risk factors for PCI.The TOAST subtypes of PCI with VAH were mainly attributed to small arteries occlusions (10/18).8 patients with cerebral infarctions which were located at pons,thala-mus and temporal occipital lobe infarction occurred on the opposite VAH,4 patients with cerebellar and medullary infarction occurred in the ipsilateral VAH (4/6).Conclusion VAH is common in vertigo patients,which may be an independent risk factor for PCI with certain regularity of its infarction distribution.