病因不明的孤立性眩晕患者与颅内动脉形态和脑灌注的相关性
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摘要
目的探讨病因不明的孤立性眩晕(UIV)患者与颅内动脉形态、脑灌注情况的相关性,以期为UIV的诊治提供参考。方法选取2015年1月至2018年5月反复发作的眩晕患者80例,其中UIV组47例,良性发作性位置性眩晕(BPPV)组33例,入院2 d内进行头颅CT检查,另选取同期进行头颅CT检查的健康体检者40例作为对照组。分析不同颅内动脉形态、脑灌注情况与UIV的关系,并对影响UIV的危险因素进行非条件Logistic回归分析。结果 UIV组、BPPV组高血压、血脂异常、糖尿病发生率高于对照组(P<0.05,P<0.01),UIV组高血压、血脂异常发生率高于BPPV组(P均<0.05);UIV组和BPPV组椎动脉(VA)狭窄、VA闭塞、VA优势型或VA发育不良(VAD或VAH)、基底动脉(BA)狭窄、BA发育不良(BAH)、BA弯曲(BAC)发生率分别高于对照组(P<0.05,P<0.01),且UIV组VA狭窄、VA闭塞、VAD/VAH及BAC发生率均高于BPPV组(P<0.05,P<0.01);UIV组、BPPV组相对脑血流量(rCBF)降低、相对脑血容量(rCBV)降低、平均通过时间(MTT)延迟、达峰时间(TTP)延迟发生率分别均高于对照组(P<0.05,P<0.01),UIV组rCBF降低、rCBV降低发生率高于BPPV组(P<0.05)。非条件Logistic回归分析显示,高血压、血脂异常、VAD或VAH、rCBF降低、rCBV降低是UIV发生的独立危险因素(P<0.05,P<0.01)。结论在合并血管危险因素的基础上,颅内后循环基底椎动脉形态异常引起的小脑和脑干低灌注与UIV的发生具有相关性。
Objective To investigate the correlation between undetermined isolated vertigo(UIV) and intracranial arterial morphology and cerebral perfusion to provide reference for the diagnosis and treatment of patients with UIV.Methods Eighty patients with recurrent vertigo from January 2015 to May 2018 were selected,including 47 patients in UIV group,33 patients with benign paroxysmal positional vertigo(BPPV) in BPPV group.All patients receiving cranial CT examination within 2 days of admission.At the same time,40 healthy subjects undergoing CT scan were served as control group.The associations of different intracranial artery morphology and cerebral perfusion with UIV was analyzed,and the unconditional logistic regression analysis was used to analyze the risk factors affecting UIV.Results The incidences of hypertension,dyslipidemia and diabetes in UIV group and BPPV group were significantly higher than those in control group(P<0.05,P<0.01).The incidences of hypertension and dyslipidemia in UIV group were higher than those in BPPV group(P<0.05).The incidences of vertebral artery(VA) stenosis,VA occlusion,VA dominance type or VA hypoplasia(VAD/VAH),basilar artery(BA) stenosis,basilar artery hypoplasia(BAH),basilar artery curvature(BAC)in UIV group and BPPV group were higher than those in control group(P<0.05,P<0.01),and the incidences of VA stenosis,VA occlusion,VAD/VAH and BAC in UIV group were higher than those in BPPV group(P<0.05,P<0.01).Compared with control group,relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),mean transit time(MTT) delay and peak time(TTP) delay significanthy increased in UIV group and BPPV group(P<0.05,P<0.01);compared with BPPV group,rCBF and rCBV increased in UIV group(P<0.05).Unconditional logistic regression analysis showed that hypertension,dyslipidemia,VAD/VAH,decline of rCBF and rCBV were the independent risk factors for UIV(P<0.05,P<0.01).Conclusion On the basis of vascular risk factors,cerebellar and brainstem hypoperfusion caused by abnormal morphology of basilar vertebral artery in intracranial posterior circulation is associated with the occurrence of UIV.
Objective To investigate the correlation between undetermined isolated vertigo(UIV) and intracranial arterial morphology and cerebral perfusion to provide reference for the diagnosis and treatment of patients with UIV.Methods Eighty patients with recurrent vertigo from January 2015 to May 2018 were selected,including 47 patients in UIV group,33 patients with benign paroxysmal positional vertigo(BPPV) in BPPV group.All patients receiving cranial CT examination within 2 days of admission.At the same time,40 healthy subjects undergoing CT scan were served as control group.The associations of different intracranial artery morphology and cerebral perfusion with UIV was analyzed,and the unconditional logistic regression analysis was used to analyze the risk factors affecting UIV.Results The incidences of hypertension,dyslipidemia and diabetes in UIV group and BPPV group were significantly higher than those in control group(P<0.05,P<0.01).The incidences of hypertension and dyslipidemia in UIV group were higher than those in BPPV group(P<0.05).The incidences of vertebral artery(VA) stenosis,VA occlusion,VA dominance type or VA hypoplasia(VAD/VAH),basilar artery(BA) stenosis,basilar artery hypoplasia(BAH),basilar artery curvature(BAC)in UIV group and BPPV group were higher than those in control group(P<0.05,P<0.01),and the incidences of VA stenosis,VA occlusion,VAD/VAH and BAC in UIV group were higher than those in BPPV group(P<0.05,P<0.01).Compared with control group,relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),mean transit time(MTT) delay and peak time(TTP) delay significanthy increased in UIV group and BPPV group(P<0.05,P<0.01);compared with BPPV group,rCBF and rCBV increased in UIV group(P<0.05).Unconditional logistic regression analysis showed that hypertension,dyslipidemia,VAD/VAH,decline of rCBF and rCBV were the independent risk factors for UIV(P<0.05,P<0.01).Conclusion On the basis of vascular risk factors,cerebellar and brainstem hypoperfusion caused by abnormal morphology of basilar vertebral artery in intracranial posterior circulation is associated with the occurrence of UIV.
引文
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[14] Lee H.Isolated vascular vertigo[J].J Stroke,2014,16(3):124-130.
[15] 孔双艳,邢岩,卫景沛,等.孤立性眩晕患者不同类型眩晕比较分析[J].神经损伤与功能重建,2015,10(4):320-321.
[16] 刘兰,刘筠,许亮.后循环缺血性眩晕患者椎基底动脉形态学改变[J].中国脑血管病杂志,2016,13(2):62-66。
[17] Byun H,Chung JH,Lee SH,et al.Increased risk of benign paroxysmal positional vertigo in osteoporosis:a nationwide population-based cohort study[J].Sci Rep,2019,9(1):3469-3474.
[2] 丘鸿凯,刘志华,赖旻瑶.孤立性眩晕患者临床特点和脑血管造影分析[J].中国医药科学,2014,4(10):187-189.
[3] Parthasarathy R,Derksen C,Saqqur M,et al.Isolated intermittent vertigo:A presenting feature of persistent trigeminal artery[J].J Neurosci Rural Pract,2016,7(1):161-163.
[4] Bhattacharyya N,Gubbels SP,Schwartz SR,et al.Clinical Practice Guideline:Isolated vertigo(Update)[J].Otolaryngol Head Neck Surg,2017,156(3 suppl):S1-S47.
[5] Samuels OB,Joseph GJ,Lynn MJ,et al.A standardized method for measuring intracranial arterial stenosis[J].AJNR Am J Neuroradiol,2000,21(4):643-646.
[6] Cepeda DE,Hains L,Li D,et al.Experimental evaluation and computational modeling of tissue damage from low-flow push-pull perfusion sampling in vivo[J].J Neurosci Methods,2015,242:97-105.
[7] 尹所,张道培,禹萌,等.基底动脉发育不全患者脑干血流动力的变化及临床意义[J].中国实用神经疾病杂志,2017,20(19):18-23.
[8] Araz Server E,Edizer DT,Yi,et al.Relationship between vertebral artery blood flow in different head positions and vertigo[J].Acta Otolaryngol,2018,138(1):1-5.
[9] 毛晓薇,毕晓莹.神经内科171例孤立性眩晕患者病因分析[J].中国卒中杂志,2016,11(5):373-377.
[10] Halmagyi GM.Brainstem stroke preceded by transient isolated vertigo attacks[J].J Neurol,2017,264(10):2170-2172.
[11] Blasberg TF,Wolf L,Henke C,et al.Isolated transient vertigo:posterior circulation ischemia or benign origin[J].BMC Neurol,2017,17(1):111.
[12] Zhang DP,LI HR,Ma QK,et al.Prevalence of Stroke and Hypoperfusion in Patients With Isolated Vertigo and Vascular Risk Factors[J].Front Neurol,2018,14(9):1110.
[13] Feil K,Strobl R,Schindler A,et al.What Is Behind Cerebellar Vertigo and Dizziness?[J]Cerebellum,2018,14(12):143-149.
[14] Lee H.Isolated vascular vertigo[J].J Stroke,2014,16(3):124-130.
[15] 孔双艳,邢岩,卫景沛,等.孤立性眩晕患者不同类型眩晕比较分析[J].神经损伤与功能重建,2015,10(4):320-321.
[16] 刘兰,刘筠,许亮.后循环缺血性眩晕患者椎基底动脉形态学改变[J].中国脑血管病杂志,2016,13(2):62-66。
[17] Byun H,Chung JH,Lee SH,et al.Increased risk of benign paroxysmal positional vertigo in osteoporosis:a nationwide population-based cohort study[J].Sci Rep,2019,9(1):3469-3474.