目的:探讨成人型烟雾病合并后循环病变发生的相关危险因素,以期指导临床诊治。方法:回顾性分析2009年3月~2010年1月于解放军307医院神经外科就诊并住院的成人烟雾病患者418例,根据是否合并后循环病变(大脑后动脉病变为主)分为合并后循环病变组130例,未合并后循环病变组为288例。分别记录患者的的性别、年龄、籍贯、临床表现类型、铃木分期、既往病史(高血压、高脂血症、高血糖)、不良生活习惯(吸烟、饮酒),是否有烟雾病家族史。对其进行组间对比及logistic回归法进行变量分析。结果:阳性家族史是成人烟雾病患者合并后循环病变的独立危险因素(OR=3.898,95%CI:1.103~13.776,P=0.035),而其余观察指标均无明显相关性(P〉0.05);相对于只存在前循环病变的患者,成人烟雾病合并后循环病变的患者较易出现卒中及头痛,脑出血相对较少;此类患者于31-40岁组出现小高峰。结论:阳性家族史是成人烟雾病患者合并后循环病变的独立危险因素,患者的临床表现较重,治疗后仍可出现反复卒中。
Objective: To investigate the relevant risk factors of the adult patients with moyamoya disease involved with posterior circulation lesions and guid the clinical diagnosis and treatment.Methods: According to whether they had posterior circulation lesions(most of the posterior cerebral artery lesions) in moyamoya disease,418 adult patients were divided into two groups: group with posterior circulation lesions including 130 patients and the other group including 288 patients.The clinical data including gender,age,native place,the types of clinical manifestations,Suzuki's staging,medical history(hypertension,hyperlipoidemia,hyperglycemia),bad habits(smoke,drink) and positive family history were collected and the relationship of clinical data between two groups was analyzed.Results: By the comparison between groups and the multiple logistic regression analysis: positive family history was the independent risk factors for adult moyamoya disease patients with posterior circulation lesions.The rest of the observed indicators had no significant correlation(P0.05);the incidence of stroke and headache is higher,but the incidence of cerebral hemorrhage is lower than that of patients suffering from anterior circulation lesion;there was a disease peak in the age distribution from 31 to 40 years.Conclusion: Positive family history was the independent risk factors for adult moyamoya disease patients with posterior circulation lesions,who could have poorer conditions and stroke repeatedly after treatment.