椎动脉优势与基底动脉弯曲的关系及其对脑梗死发生的影响

目的研究椎动脉优势与基底动脉弯曲的关系及其对脑桥或小脑后下动脉供血区脑梗死发生的影响。方法选取神经内科收治的小脑后下动脉供血区或脑桥处梗死急性期的患者112例。通过分析患者的影像学资料,了解其脑梗死、双侧椎动脉和基底动脉的情况,并分析发生中重度基底动脉弯曲的危险因素。结果左侧椎动脉优势77例(68.75%),右侧椎动脉优势35例(31.25%),中重度基底动脉弯曲59例(52.68%)。随着椎动脉直径差异级别的升高,原发性高血压病、中重度基底动脉弯曲的发生率显著增高,右侧椎动脉直径显著变小,差异具有统计学意义(P均<0.05)。基底动脉中重度弯曲患者的平均年龄、原发性高血压病的比例、椎动脉直径差异3级的比例均显著高于无基底动脉中重度弯曲的患者,而椎动脉直径差异1级的患者比例则显著低于无基底动脉中重度弯曲的患者(P<0.05)。多因素Logistic回归分析显示,椎动脉直径差异为中重度基底动脉弯曲的独立危险因素(OR=2.79,95%CI 1.24～6.08,P=0.001)。结论双侧椎动脉直径差异越大,基底动脉弯曲程度越大,发生脑桥和小脑后下动脉供血区脑梗死的风险越高。

Relationship between the vertebral artery dominance and basilar artery curvature and its influence on the incidence of cerebral infarction

Objective To investigate the relationship between vertebral artery dominance and basilar artery curvature and its influence on the incidence of acute cerebral infarction,which happened in the pons or posterior inferior cerebellar artery supply area.Methods 112 patients with acute cerebral infarction happened in the pons or posterior inferior cerebellar artery supply area were selected.The risk factor of severe basilar artery curvature by understanding the image data of cerebral infarction, bilateral vertebral artery and basilar artery were analyzed.Results The vertebral artery dominance in left was 77 cases （68.75%）,while 35 cases were in right（31.25%）.There were 59 cases with severe basilar artery curvature（52.68%）. With the level of the vertebral artery diameter difference increase,the occurrence rate of hypertension and severe basilar artery curvature were significantly increased,and the right vertebral artery diameter was significantly smaller the differences were statistically significant（all P 0.05）.The average age,proportion of primary hypertension and proportion of the vertebral artery diameter difference of level 3 in patients with severe bending in the basilar artery were significantly higher than the patients without severe bending basilar artery,while the proportion of vertebral artery diameter difference of level 1 was significantly lower than the patients without bending basilar artery（P 0.05）.Multivariate Logistic regression analysis showed that independent risk factor for severe basilar artery curvature was the vertebral artery diameter difference（OR =2.79,95%CI 1.24～6.08,P =0.001）.Conclusion Bilateral vertebral artery diameter difference was independent risk factor of severe basilar artery curvature.With the difference of vertebral artery diameter and basilar artery curvature increased,the risk of infarction in the pons and posterior inferior cerebellar artery was increased.