摘要目的 探讨成年烟雾病患者脑微出血的分布模式,及其与颅内血管形态学的联系.方法 连续入选南京军区南京总医院2009年6月至2011年6月间首次经脑血管造影证实的成年烟雾病患者71例.对所有患者进行3.0T磁共振磁敏感成像检查并依照脑微出血病灶的分布区域分组.比较各组间包括年龄、性别、高血压、糖尿病、高脂血症、临床症状、起病时间以及血浆纤维蛋白原水平在内的基线危险因素,颅底烟雾血管铃木分级,后循环受累情况以及脉络膜前动脉-后交通动脉(AChA-PComA)分级等颅内血管形态学特点的关系.结果 于23例患者的25侧半球中检出30处脑微出血灶,其分布以深部侧脑室旁白质为主,占70.0％(21/30).根据脑微出血解剖定位标准将所有142侧半球分为无脑微出血组、侧脑室旁深部白质脑微出血组及其他部位脑微出血组.单因素分析提示年龄及AChA-PComA极度延长扩张的比例有可能与脑微出血病灶分布模式有关.进一步进行多因素回归分析显示:相对无脑微出血半球,AChA-PComA的极度延长扩张是深部侧脑室旁白质区域脑微出血病灶的影响因素之一(OR =3.090,95％CI1.050 ～ 9.140,P=0.041),而与其他部位的脑微出血病灶无明显关联(OR=1.680,95％CI0.390 ～7.190,P=0.483).结论 成年型烟雾病患者微出血病灶主要分布于深部侧脑室旁白质.这种特征性的分布模式可能与AChA-PComA的形态学变化有关.

abstractsObjective To investigate the relationship between cerebral microbleeds (CMBs) and morphology of intracranial arteries in adult patients with moyamoya disease.Methods Seventy-one adult patients with first catheter-based angiography confirmed moyamoya disease in Jinling Hospital from June 2009 to June 2011 were enrolled in the present study.Clinical baseline parameters in each patient include age,gender,history of hypertension,diabetes,hyperlipidemia,clinical symptoms,onset time and plasma fibrinogen were collated.All of the patients underwent susceptibility-weighted imaging of 3.0 T magnetic resonance imaging system to detect the CMBs foci.According to the angiographies,the relationship between distribution patterns of CMBs and the morphology of intracranial arteries including Suzuki stages of moyamoya vessels at the base of brain,posterior circulation involvement as well as the stages of dilation and extension of anterior choroidal artery-posterior communicating arteries (AChA-PComA) were analyzed.Results A total of 30 CMBs foci in 25 hemispheres were separately found among 142 hemispheres of the entire 71 patients.Seventy percent (21/30) CMBs foci located in the regions of deep and periventricular white matter (DPWM).The total 142 hemispheres were categorized into non-CMBs group,DPWM-CMBs group and other region-CMBs group according to microbleeds anatomy rating scale.Univariate analysis suggested that age and the proportion of extremely dilation and extension of AChA-PComA might be potentially related to the distribution of CMBs.Further multinomial logistic regression analysis suggested that,extremely dilation and extension of AChA-PComA was an independent predictor for CMBs located in DPWM (OR =3.090,95％ CI1.050-9.140,P =0.041) rather than in other regions (OR =1.680,95％ CI 0.390-7.190,P =0.483),compared with non-CMBs group hemispheres . Conclusions CMBs in patients with moyamoya disease usually locate in the region of DPWM.This specific distribution patterns might be related to the morphology variation of AChA-PComA.