高血压对大脑中动脉闭塞患者软脑膜侧支循环的影响
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摘要
目的探讨高血压对大脑中动脉闭塞(MCAO)患者软脑膜侧支循环建立的影响。方法 2007～2016年在首都医科大学附属北京友谊医院神经内科住院的动脉粥样硬化所致脑梗死的患者中,纳入头颈部CTA证实的动脉粥样硬化所致的大脑中动脉近端闭塞患者进行回顾性研究。以软脑膜侧支循环建立的等级为指标,分为代偿充分组(1～2级)和代偿非充分组(3～5级),采用单因素分析的方法,探讨高血压与软脑膜侧支循环等级的相关性。结果共纳入患者204例,平均年龄为(62. 4±10. 2)岁,男性144例(70. 6%)。合并高血压的患者为140例,其中软脑膜侧支循环代偿充分者为89例(63. 6%),非充分者为51例(36. 4%);未合并高血压的患者为64例,其中软脑膜侧支循环代偿充分者为31例(48. 4%),非充分者为33例(51. 6%)。高血压与MCAO患者软脑膜侧支循环等级呈正相关(P=0. 042)。结论合并高血压的MCAO患者,其软脑膜侧支循环的建立较未合并高血压患者充分,高血压对MCAO患者软脑膜侧支循环可能起促进作用。
Objective To explore the influence of hypertension( HT) on leptomeningeal collaterals in patients with middle cerebral artery occlusion( MCAO). Methods The clinical data of patients with MCAO from neurology department of this hospital for stroke during 2007 to 2016 were retrospectively reviewed and studied. These patients with MCAO were confirmed by head and neck CTA,they were divided into good lepto-meningeal collaterals group( 1 ～ 2 grade) and poor leptomeningeal collaterals group( 3 ～ 5 grades) according to grade of leptomeningeal collaterals,and analyzing the relationship between HT and leptomeningeal collaterals. Results Two hundred and four patients were selected. Their mean age was( 62. 4 ± 10. 2) years old,and 144( 70. 6%) patients were males. Among these 140 patients with HT,89 cases( 63. 6%) had good leptomeningeal collaterals,while 51( 36. 4%) of them had poor ones. Among these 64 patients without HT,31 cases( 48. 4%) had good leptomeningeal collaterals,while 33 cases( 51. 6%) had poor ones. There is positive correlation between HT and leptomeningeal collaterals( P = 0. 042).Conclusion Patients with HT coomplicated with MCAO had better leptomeningeal collaterals than patients without HT. HT may play a positive role in promoting leptomeningeal collaterals.
Objective To explore the influence of hypertension( HT) on leptomeningeal collaterals in patients with middle cerebral artery occlusion( MCAO). Methods The clinical data of patients with MCAO from neurology department of this hospital for stroke during 2007 to 2016 were retrospectively reviewed and studied. These patients with MCAO were confirmed by head and neck CTA,they were divided into good lepto-meningeal collaterals group( 1 ～ 2 grade) and poor leptomeningeal collaterals group( 3 ～ 5 grades) according to grade of leptomeningeal collaterals,and analyzing the relationship between HT and leptomeningeal collaterals. Results Two hundred and four patients were selected. Their mean age was( 62. 4 ± 10. 2) years old,and 144( 70. 6%) patients were males. Among these 140 patients with HT,89 cases( 63. 6%) had good leptomeningeal collaterals,while 51( 36. 4%) of them had poor ones. Among these 64 patients without HT,31 cases( 48. 4%) had good leptomeningeal collaterals,while 33 cases( 51. 6%) had poor ones. There is positive correlation between HT and leptomeningeal collaterals( P = 0. 042).Conclusion Patients with HT coomplicated with MCAO had better leptomeningeal collaterals than patients without HT. HT may play a positive role in promoting leptomeningeal collaterals.
引文
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[13]Christoforidis GA,Mohammad Y,Kehagias D,et al.Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke[J].AJNR Am J Neuroradiol,2005,26(7):789-1797.
[14]Mouquet F,Cuilleret F,Susen S,et al.Metabolic syndrome and collateral vessel formation in patients with documented occluded coronary arteries:association with hyperglycaemia,insulin-resistance,adiponectin and plasminogen activator inhibitor-1[J].Eur Heart J,2009,30(7):840-849.
[15]Losordo DW,Isner JM.Estrogen and angiogenesis:A review[J].Arterioscler Thromb Vasc Biol,2001,21(1):6-12.
[16]Pohl T,Seiler C,Billinger M,et.al.Frequency distribution of collateral flow and factors influencing collateral channel development.Functional collateral channel measurement in 450 patients with coronary artery disease[J].J Am Coll Cardiol,2001,38(7):1872-1878.
[2]Christoforidis GA,Mohammad Y,Kehagias D,et al.Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke[J].AJNR Am J Neuroradiol,2005,26(7):1789-1797.
[3]Kim JH,Kang HI,Moon BG,et al.Assessment of recanalization after intra-arterial thrombolysis in patients with acute ischemic stroke:proposed modification of the qureshi grading system[J].J Korean Neurosurg Soc,2012,51(5):262-267.
[4]Bang OY,Saver JL,Buck BH,et al.Impact of collateral flow on tissue fate in acute ischaemic stroke[J].J Neurol Neurosurg Psychiatry,2008,79(6):625-629.
[5]Wufuer A,Mijiti P,Abudusalamu R,et al.Blood pressure and collateral circulation in acute ischemic stroke[J].Herz,2018,(12):1-5.
[6]Gersing AS,Schwaiger BJ,Kleine JF,et al.Clinical Outcome Predicted by Collaterals Depends on Technical Success of Mechanical Thrombectomy in Middle Cerebral Artery Occlusion[J].J Stroke Cerebrovasc Dis,2017,26(4):801-808.
[7]Koerselman J,de Jaegere PP,Verhaar MC,et al.High blood pressure is inversely related with the presence and extent of coronary collaterals[J].J Hum Hypertens,2005,19(10):809-817.
[8]Li CC,Yang TL,Pu XQ,et al.Formation and function of coronary collateral circulation and their influencing factors[J].Zhong Nan Da Xue Xue Bao Yi Xue Ban,2004,29(6):693-696.
[9]王拥军.脑侧支循环及氧化应激对其影响[J].中国卒中杂志,2008,3(3):198-201.
[10]Lazzaro MA,Chen M,Christoforidis GA,et al.The impact of diabetes on the extent of pial collaterals in acute ischemic stroke patients[J].JNeurointerv Surg,2011,3(3):242-245.
[11]Akamatsu Y,Nishijima Y,Lee CC,et al.Impaired Leptomeningeal Collateral Flow Contributes to the Poor Outcome following Experimental Stroke in the Type 2 Diabetic Mice[J].J Neurosci,2015,35(9):3851-3864.
[12]Nishijima Y,Akamatsu Y,Yang SY,et al.Impaired collateral flow compensation during chronic cerebral hypoperfusion in the type-II-diabetic mice[J].Stroke,2016,47(12):3014-3021.
[13]Christoforidis GA,Mohammad Y,Kehagias D,et al.Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke[J].AJNR Am J Neuroradiol,2005,26(7):789-1797.
[14]Mouquet F,Cuilleret F,Susen S,et al.Metabolic syndrome and collateral vessel formation in patients with documented occluded coronary arteries:association with hyperglycaemia,insulin-resistance,adiponectin and plasminogen activator inhibitor-1[J].Eur Heart J,2009,30(7):840-849.
[15]Losordo DW,Isner JM.Estrogen and angiogenesis:A review[J].Arterioscler Thromb Vasc Biol,2001,21(1):6-12.
[16]Pohl T,Seiler C,Billinger M,et.al.Frequency distribution of collateral flow and factors influencing collateral channel development.Functional collateral channel measurement in 450 patients with coronary artery disease[J].J Am Coll Cardiol,2001,38(7):1872-1878.