【作者】 金鑫；

【导师】 张仁生；

【作者基本信息】 吉林大学 ， 临床医学硕士（神经病学）（专业学位）， 2021， 硕士

【摘要】 目的:椎动脉优势(vertebral artery dominance,VAD)是指双侧VA一侧管径较大或双侧管径相等时一侧VA与BA呈直线形连接的血管变异现象。人群中35.5-58%的人为左侧VAD,右侧VAD为19-35.7%[8,9]。现阶段研究认为VAD可能是PCI的危险因素[10]。与前循环缺血相比,后循环缺血患者发现椎动脉管径不对称的发生率更高,并与基底动脉(Basilar Artery,BA)弯曲相关[11]。BA是人身体唯一一个由两条动脉合并成的动脉,弯曲时具有特殊的血流动力学改变。探索VAD发生时椎-基底动脉交界处的发生的血流动力学改变,分析其与基底动脉弯曲的关系,以及它们参与后循环缺血的过程,有助于为PCI的形成机制及诊断治疗提供新的思路及参考。方法:以2019年7月-2020年12月之间在吉林大学第一医院二部神经内科住院治疗的123例PCI患者及53例健康门诊体检的患者为研究对象,收集上述176例患者的临床资料,所有患者均完成头颅MRI、头MRA、经颅彩色超声多普勒、颈部彩色超声多普勒检查,根据颈部彩色超声多普勒所测双侧椎动脉直径,结合头颅MRA所见,将研究对象分为椎动脉优势组(VAD组)及椎动脉非优势组(non-VAD组)。详尽记录每例患者临床资料,常见脑血管疾病的危险因素,并通过化验检查来评估危险因素。记录椎动脉、基底动脉、大脑后动脉收缩期峰值流速(Vs)、舒张期流速(Vd)、平均血流流速(Vm)、搏动指数(PI)、阻力指数(RI)。根据MRA测量并记录基底动脉理论长度及弯曲长度,对BA弯曲进行分级。比较上述脑血管病危险因素,血流速度等血流动力学数据在有无VAD时的差别,以及VAD与BA弯曲程度分级和后循环缺血严重程度的相关性。结果:1.颅外段VAD组椎动脉:Vs、Vd、Vm:优势侧>非优势侧(P<0.05);RI:优势侧<非优势侧(P<0.05);颅外段VAD组优势侧椎动脉与non-VAD组双侧椎动脉相比:Vs、Vd、Vm:VAD组>non-VAD组(P<0.05);RI:优势组<non-VAD组(P<0.05);颅内段VAD组椎动脉:Vs、Vd、Vm:优势侧>非优势侧(P<0.05);PI、RI:优势侧<非优势侧(P<0.05);颅内段VAD组优势侧椎动脉与non-VAD组双侧椎动脉相比:Vs、Vd、Vm:VAD组>non-VAD组(P<0.05);PI、RI:VAD 组<non-VAD 组(P<0.05);2.VAD组优势侧与非优势侧大脑后动脉:Vs、Vd、Vm:优势侧>非优势侧(P<0.05),PI、RI:统计学无显著性差异(P>0.05);VAD 组与 non-VAD组基底动脉Vs相比统计学无显著性差异(P>0.05),Vd、Vm:VAD组<non-VAD组(P<0.05);PI、RI:VAD 组>non-VAD 组(P<0.05);基底动脉理论长度:VAD组>non-VAD组(P<0.05);基底动脉弯曲度:VAD组>non-VAD组(P<0.05);3.176例患者中,PCI患者123例,其中后循环TIA患者64例,后循环脑梗死患者59例;健康对照组53例,健康对照组BA中/重度弯曲患者8例(占15.1%);后循环TIA患者BA中/重度弯曲患者22例(占34.4%);后循环脑梗死患者BA中/重度弯曲患者占30例(占50.8%);PCI、BA弯曲、VAD三因素行相关分析提示两两之间存在正相关关系;4.后循环缺血发生的严重程度与基底动脉弯曲和椎动脉优势有关,基底动脉弯曲3级、2级、1级、与弯曲0级人群相比,后循环缺血至少严重1个等级的可能性分别是7.565(P=0.001)、2.042(P=0.182)、2.701(P=0.021)倍。存在椎动脉优势与无椎动脉优势人群相比,后循环缺血至少严重1个等级的可能性是5.062(P<0.001)倍。结论:1.在后循环缺血的患者中,椎动脉优势患者椎动脉的血流速度明显高于非优势侧及无椎动脉优势的患者,椎动脉优势患者优势侧大脑后动脉血流速度明显高于非优势侧。2.在后循环缺血的患者中,椎动脉优势的患者基底动脉血流速度明显低于无椎动脉优势的患者,基底动脉的弯曲程度和理论长度明显高于无椎动脉优势的患者。3.后循环缺血、基底动脉弯曲程度和椎动脉优势三者之间具有相关性。存在椎动脉优势、基底动脉弯曲程度分级越高,后循环缺血事件严重程度越高。更多还原

【Abstract】 Object:Vertebral artery dominance(VAD)refers to the linear connection between VA and BA when the diameter of both sides of VA is larger or the diameter of both sides is equal.35.5-58%of the population have left VAD,and right VAD is 19-35.7%.[8,9].Research at this stage believes that VAD may be a risk factor for PCI[10].Compared with anterior circulation ischemia,patients with posterior circulation ischemia have a significantly higher incidence of vertebral artery diameter asymmetry,which is related to the curvature of the basilar artery(Basilar Artery,BA)[11].BA is the only artery in the human body that is formed by the merger of two arteries,with special hemodynamic changes.Explore the hemodynamic changes that occur at the vertebral-basal artery junction when VAD occurs,study the formation of vertebral artery dominance,analyze its involvement in basilar artery bending,and their involvement in the process of posterior circulation ischemia,which is helpful for PCI The formation mechanism and diagnosis and treatment provide new ideas and references.Method:Taking 123 PCI patients and 53 healthy outpatient physical examination patients who were hospitalized in the Second Department of Neurology of the First Hospital of Jilin University between July 2019 and December 2020 as the research objects,the clinical data of the above 176 patients were collected.All patients have completed cranial MRI,MRA,transcranial color Doppler ultrasound,and carotid artery color Doppler.According to the diameter of the bilateral vertebral arteries measured by carotid color ultrasound,combined with transcranial color Doppler ultrasound and cranial MRA,the study The subjects were divided into vertebral artery dominant group(VAD group)and vertebral artery non-dominant group(non-VAD group).Detailed records of each patient’s clinical data,common risk factors for cerebrovascular diseases,and assessment of risk factors through laboratory tests.Results:1.Vertebral artery in extracranial VAD group:Vs,Vd,Vm:dominant side>non-dominant side(P<0.05);RI:dominant side<non-dominant side(P<0.05);dominant side vertebra in extracranial VAD group Artery compared with bilateral vertebral arteries in non-VAD group:Vs,Vd,Vm:VAD group>non-VAD group(P<0.05);RI:dominant group<non-VAD group(P<0.05);intracranial segment VAD group vertebral artery:Vs,Vd,Vm:dominant side>non-dominant side(P<0.05);PI,RI:dominant side<non-dominant side(P<0.05);intracranial VAD group dominant vertebral artery and non-Comparison of bilateral vertebral arteries in VAD group:Vs,Vd,Vm,VAD group>non-VAD group(P<0.05);PI,RI:superior group<non-VAD group(P<0.05);2.VAD group and dominant side and non-dominant posterior cerebral artery:Vs,Vd,Vm:dominant side>non-dominant side(P<0.05),PI,RI:statistically no significant difference(P>0.05);VAD There was no significant difference in basilar artery Vs between the non-VAD group and the non-VAD group(P>0.05),Vd,Vm:VAD group<non-VAD group(P<0.05);PI,RI:VAD group>non-VAD group(P<0.05);theoretical length of basilar artery:VAD group>non-VAD group(P<0.05);basilar artery curvature:VAD group>non-VAD group(P<0.05);3.Among the 176 patients,123 were PCI patients,including 64 patients with posterior circulation TIA and 59 patients with posterior circulation cerebral infarction;53 patients in the healthy control group,and 8 patients in the healthy control group with BA moderate/severe curvature(accounting for 15.1%);There were 22 patients with BA moderate/severe curvature in circulatory TIA patients(34.4%);30 patients with BA moderate/severe curvature in patients with posterior circulation cerebral infarction(50.8%).The correlation analysis of the three factors of PCI,BA bending,and VAD indicates that there is a positive correlation between the two;4.The severity of posterior circulation ischemia is related to basilar artery curvature and vertebral artery superiority.Basilar artery curvature is grade 3,grade 2,and grade 1.Compared with people with grade 0 curvature,posterior circulation ischemia is at least one grade more likely They are 7.565(P=0.001),2.042(P=0.182),2.701(P=0.021)times.Compared with people without vertebral artery dominance,the possibility that posterior circulation ischemia is at least one grade severe is 5.062(P<0.001)times.Conclusion:1.In patients with posterior circulation ischemia,the blood flow velocity of the vertebral artery in patients with vertebral artery dominance is significantly higher than that of the non-dominant side and patients without vertebral artery dominance,and the blood flow velocity of posterior cerebral artery in patients with vertebral artery dominance is significantly higher than that of non-dominant patients.side.2.Among patients with posterior circulation ischemia,the blood flow velocity of the basilar artery in patients with vertebral artery dominance is significantly lower than that of patients without vertebral artery dominance,and the curvature and theoretical length of the basilar artery are significantly higher than those without vertebral artery dominance.3.The posterior circulation ischemia,the degree of basilar artery curvature and the vertebral artery dominance are correlated.The presence of vertebral artery superiority and the higher the degree of basilar artery curvature,the higher the severity of posterior circulation ischemic events.更多还原