【作者】 徐鹏；

【导师】 刘佳梅；

【作者基本信息】 吉林大学 ， 人体解剖与组织胚胎学， 2023， 硕士

【摘要】 目的:本研究探讨蒙古族后循环缺血患者椎-基底动脉血管的解剖形态分类以及不同血管形态下基底动脉(BA)斑块发生情况。方法:本研究收集了2019年7月至2022年3月在本院经神经内科临床诊断为PCI的患者,经纳入及排除标准后共600例,分别是蒙古族患者300例,汉族患者300例。对所有患者采用3.0T磁共振扫描成像,根据结果将患者分为有斑块组和无斑块组,探讨PCI患者的一般资料与BA斑块形成的相关性;并根据成像的解剖形态将椎-基底动脉系统的解剖形态分为四型,Walking型,No Confluence型,Tuning Fork型,Lambda型,研究这四种椎-基底动脉形态中基底动脉斑块发生情况。后按双侧椎动脉(VA)血管弯曲总数,探讨多弯曲组和少弯曲组椎-基底动脉不同解剖形态下不同的血管弯曲数下BA斑块的发生率;并使用统计学软件SPSS 20.0对收集资料进行分析和对比。结果:1.BA有斑块组和无斑块组基础资料对比:蒙古族患者与汉族患者有斑块和无斑块两组临床资料中年龄、BMI、吸烟史、饮酒史、高脂血症等方面,差异均无统计学意义(P>0.05)。2.比较蒙古族患者与汉族患者高血压糖尿病患病率:经统计学分析蒙古族患者有斑块和无斑块两组的高血压患病率、糖尿病患病率差异有统计学意义。汉族患者有斑块和无斑块两组的高血压患病率、糖尿病患病率差异无统计学意义。进一步地比较有斑块组患者,蒙古族和汉族患者高血压患病率及糖尿病患病率,差异有统计学意义。3.四种椎-基底动脉解剖形态的分类比例及基底动脉斑块形成情况蒙古族所有患者中,四种椎-基底动脉血管形态中BA斑块的发生率差异具有统计学意义。在本研究中,Walking型血管形态占比最高,No Confluence型的BA斑块发生率最高,Tuning Fork型BA斑块发生率最低。汉族所有患者中,四种椎-基底动脉血管形态中BA斑块的发生率差异无统计学意义。在本研究中,Tuning Fork型血管形态占比最高。进一步比较有斑块组,汉族和蒙古族患者的四种椎-基底动脉形态,结果显示在Tuning Fork型差异有统计学意义,在Walking型、No Confluence型及Lambda型差异没有统计学意义。4.两侧椎动脉颅内段血管弯曲数多少与BA斑块形成的关系(1)在蒙古族患者中,Tuning Fork型有45例,其中多弯曲组与少弯曲组BA斑块发生率差异无统计学意义。在汉族患者中,Tuning Fork型有91例,其中多弯曲组与少弯曲组BA斑块发生率差异无统计学意义。进一步地比较蒙古族BA有斑块组和汉族BA有斑块组在多弯曲组上结果显示汉族患者斑块发生率较高,差异有统计学意义;在少弯曲组上结果显示差异无统计学意义。(2)在蒙古族患者中Walking型有107例,其中多弯曲组斑块发生率高于少弯曲组。在汉族患者中Walking型有73例,多弯曲组与少弯曲组BA斑块发生率差异无统计学意义。进一步地比较蒙古族BA有斑块组和汉族BA有斑块组在多弯曲组上结果显示蒙古族患者斑块发生率较高,差异有统计学意义;在少弯曲组上结果显示差异无统计学意义。(3)在蒙古族患者中No Confluence型有52例,其中多弯曲组与少弯曲组BA斑块发生率差异无统计学意义。在汉族患者中No Confluence型有47例,多弯曲组与少弯曲组BA斑块发生率差异无统计学意义。进一步地比较蒙古族BA有斑块组和汉族BA有斑块组在多弯曲组上结果显示差异无统计学意义;在少弯曲组上结果显示,蒙古族患者斑块发生率较高,差异有统计学意义。(4)在蒙古族患者中Lambda型有96例,多弯曲组与少弯曲组BA斑块发生率差异无统计学意义。在汉族患者中Lambda型有89例,多弯曲组与少弯曲组BA斑块发生率差异无统计学意义。进一步地比较蒙古族BA有斑块组和汉族BA有斑块组在多弯曲组与少弯曲组上差异均无统计学意义。结论:1、蒙古族患者椎基底动脉的各分型占比与汉族不同,四种分型中蒙古族患者Walking型占比最高(汉族Tuning Fork型最高),Tuning Fork型患者占比最低(汉族No Confluence型最低)。2、在蒙古族患者中No Confluence型基底动脉斑块更容易形成。而汉族患者的椎基底动脉形态与动脉斑块的发生情况无明显相关性。3、椎动脉颅内段血管弯曲率与斑块形成在蒙古族患者中Walking型呈正相关。在多弯曲组中Walking型蒙古族患者的斑块形成率比汉族患者更高,而Tuning Fork型更低;在少弯曲组中No Confluence型蒙古族患者的斑块形成率比汉族患者更高。4、蒙古族患者高血压、糖尿病与基底动脉斑块的形成存在相关性:在有动脉斑块的患者中,高血压、糖尿病的患者发生率蒙古族比汉族更高。更多还原

【Abstract】 Objective:To investigate the anatomic classification of vertebral-Basilar artery and the prevalence of Basilar artery(BA)plaques in different vascular morphologies in patients with posterior circulation ischemia in Mongols.Methods:A total of 600 patients,including 300 Mongols patients,who were clinically diagnosed as having undergone PCI in our department of Neurology from July 2019 to March 2022,were included in this study,300 patients of Han nationality.All patients were scanned with 3.0 T magnetic resonance imaging and divided into plaque group and non-plaque group according to the results According to the imaging morphology,the vertebrobasilar artery system was divided into four types: Walking type,No Confluence type,Tuning Fork type and Lambda type.According to the total number of bending vessels of bilateral vertebral artery(VA),the incidence of BA plaque in multi-bending group and less-bending group was studied Statistical Software SPSS20.0 was used to analyze and compare the collected data.Results:1.Comparison of baseline data between the BA Group and the no-plaque GroupThere were no significant differences in age,BMI,smoking history,drinking history and hyperlipidemia between the two groups(p > 0.05).2.Comparison of prevalence of hypertension and diabetes mellitus between Mongols patients and Han nationality patientsThere were significant differences in the prevalence of hypertension and diabetes between the plaque and non-plaque groups in Mongols.There was no significant difference in the prevalence of hypertension and diabetes between the two groups.Further,there were significant differences in the prevalence of hypertension and diabetes between the plaque group,Mongols and Han Chinese.3.The classified proportion of the four vertebral-basilar artery anatomic forms and the status of basilar artery plaque formationThere was a statistically significant difference in the incidence of BA plaque among the four vertebrobasilar vascular morphologies in all patients in the Mongols.In this study,Walking type had the highest proportion of vascular morphology,No Confluence type had the highest incidence of BA plaque,and Tuning Fork type had the lowest incidence of BA plaque.There was no significant difference in the incidence of BA plaque among the four types of vertebral-basilar vascular morphology in all patients of Han nationality.Tuning Fork vascular morphology was the highest in this study.A further comparison of the four vertebrobasilar artery patterns in the plaque group,Han Chinese,and Mongols patients showed a statistically significant difference in Tuning Fork patterns,there was no significant difference among Walking type,No Confluence type and Lambda type.4.The relationship between the number of intracranial vascular bends of bilateral vertebral artery and the formation of BA plaque(1)In 45 Mongols patients with the Tuning Fork type,there was no significant difference in the incidence of BA plaques between the more-curved group and the less-curved group.There were 91 cases of Tuning Fork type in Han nationality,and there was no significant difference in the incidence of BA plaque between the multi-bend group and the few-bend group.A further comparison between the BA with plaque in Mongols and the BA with plaque in the Han nationality showed a higher prevalence of plaque in the multi-bend group,and the difference was statistically significant There was no significant difference between the two groups.(2)There were 107 Walking type patients in the Mongols,with a higher incidence of plaque in the more-curved group than in the less-curved group.There were 73 Walking type patients in Han nationality.There was no significant difference in the incidence of BA plaque between the multi-bend group and the few-bend group.A further comparison between the BA with plaque group in Mongols and the BA with plaque group in the Han nationality showed that the prevalence of plaque was higher in the Mongols group,and the difference was statistically significant There was no significant difference between the two groups.(3)There were 52 cases of No Confluence type in Mongols,and there was No significant difference in the incidence of BA plaque between the more curved group and the less curved group.There were 47 cases of No Confluence type in Han nationality patients.There was No significant difference in the incidence of BA plaque between the multi-bend group and the few-bend group.Further comparison between the BA with plaque group and the BA with plaque group showed no significant difference in the multi-bend group,while the low-bend group showed a higher prevalence of plaque in the Mongols,the difference was statistically significant.(4)There were 96 cases of Lambda type in Mongols,and there was no significant difference in the incidence of BA plaque between the more bending group and the less bending group.There were 89 cases of Lambda type in Han nationality.There was no significant difference in the incidence of BA plaque between the multi-bend group and the slightly bend group.Further,there was no significant difference between the BA with plaque group and the BA with plaque group in Mongols,China,on the multiple curvature group and the few curvature group.Conclusion:1.The ratio of vertebrobasilar artery types in Mongols was different from that in the Han nationality.The ratio of Walking type was the highest in Mongols(Tuning Fork type was the highest in the Han nationality),and the ratio of Tuning Fork type was the lowest(No Confluence type was the lowest in the Han nationality).2.No Confluence type basilar artery plaque is more likely to form in Mongols patients.However,there was no significant correlation between vertebrobasilar artery morphology and arterial plaque in Han nationality patients.3.The curvature of the intracranial segment of the vertebral artery was associated with plaque formation and was positively associated with Walking type in Mongols patients.Plaque formation was higher in Walking type Mongols than in Han Chinese,and lower in Tuning Fork type,and higher in No Confluence type Mongols than in Han Chinese in the less curved group.4.Hypertension and diabetes are associated with plaque formation in Mongols Mongols,where the prevalence of hypertension and diabetes is higher than in the Han population.更多还原