【作者】 蒲朝霞；

【导师】 王建安；

【作者基本信息】 浙江大学 ， 内科学， 2011， 博士

【摘要】 颅内动脉瘤是由于局部血管异常改变产生的脑血管瘤样突起,是造成蛛网膜下腔出血的首位病因。脑血管意外中,颅内动脉瘤破裂出血仅次于脑血栓、高血压脑出血,位居第三。临床上颅内动脉瘤破裂前多无症状,诊断也较为困难,常常在并发出血时才被发现,且存活者中50-70%遗留有严重的残疾,给社会和家庭带来沉重的负担,因而迫切需要早期监测指标来降低该病的致残率及死亡率。颅内动脉瘤的发病是多因素的,先天性血管壁发育不良、颅内动脉获得性退行性病变导致血管破坏被认为是颅内动脉瘤的发病原因之一。颅内动脉瘤自身的研究现已多见,但目前尚未见对该病的大血管结构及弹性功能的报道。因此,我们应用无创的经胸超声心动图,以升主动脉及腹主动脉内径、升主动脉弹性功能为主要指标进行了以下两部分研究,希望能为颅内动脉瘤的病因学研究及临床早期监测提供依据。第一部分升主动脉、腹主动脉内径与颅内动脉瘤的相关性研究研究背景术中影像和病理学研究表明先天性血管壁发育不良、颅内动脉获得性退行性病变是颅内动脉瘤的发病原因之一。但颅内动脉瘤患者的大动脉,如升主动脉、腹主动脉内径大小；是否易发升主动脉、腹主动脉瘤等情况不甚明了。因此,为了解颅内动脉瘤患者的升主动脉、腹主动脉内径与颅内动脉瘤的相关性,我们对107例颅内动脉瘤患者的主动脉内径进行了详细分析并加以统计分析。目的评估颅内动脉瘤患者的升主动脉、腹主动脉内径与颅内动脉瘤的相关性。方法选择经DSA确诊的107例颅内动脉瘤患者(其中伴发高血压者57例)及108例健康者为正常对照,经胸二维超声心动图分别测量并比较各组舒张末期升主动脉、腹主动脉各段内径。结果颅内动脉瘤高血压组、非高血压组与对照组经体表面积校正后的主动脉各段内径各组间均值均无统计学差异,单因素相关分析表明升主动脉、腹主动脉内径大小与颅内动脉瘤无相关性(P>0.05)。结论颅内动脉瘤患者各段主动脉内径径线无明显改变。因此临床上不能以主动脉各段内径的大小作为颅内动脉瘤的发生及病情发展的检测指标。第二部分颅内动脉瘤患者主动脉弹性功能的研究研究背景动脉弹性功能减退是多种心脑血管危险因素对血管壁早期损害的综合表现。是早期血管病变的特异性和敏感性标志；而且也是一种心脑血管疾病的高危因素,参与了心脑血管疾病的发生和发展。近年来,无创评价动脉弹性功能主要用于心血管疾病的研究,而在脑血管疾病中的应用鲜为少见。本次研究以颅内动脉瘤为研究对象,运用M型超声心动图测量颅内动脉瘤患者的升主动脉内径,计算并评价该组疾患的动脉弹性功能变化,以期为颅内动脉瘤的病因学研究及临床早期防治提供可靠依据。目的评价颅内动脉瘤患者主动脉弹性功能变化及临床意义。方法选择107例颅内动脉瘤患者(其中伴发高血压者57例)和108例正常对照者,M型超声心动图测量升主动脉收缩期(AoS)及舒张期(AoD)内径,计算并比较各组主动脉弹性功能指标。结果①与正常对照组比较：颅内动脉瘤高血压组、非高血压组患者的主动脉膨胀性均(aortic distensibility, DIS)明显降低(P<0.001),而僵硬度(aortic stiffness index, SI)均明显增加(P<0.001)。②与颅内动脉瘤非高血压组比较：伴有高血压的颅内动脉瘤患者DIS明显降低(P<0.001),而SI有所升高(P<0.05,ANOVA).三组间经体表面积、体重指数校正后的校正值亦存在同样规律。结论颅内动脉瘤患者均存在主动脉弹性功能的减退,且高血压是引起该组疾患主动脉弹性功能进一步减退的原因之一。因此早期无创超声评估颅内动脉瘤患者的大动脉弹性功能对其临床治疗及预后具有重要意义。更多还原

【Abstract】 Intracranial aneurysm (IAs) is the weakness of intracranial vessels that balloons out and is apt to rupture. It is the most dangerous brain disease because of high mortality and morbidity. Cerebrovascular disease is the third leading cause of death worldwide. And rupture of intracranial aneurysms is responsible for one-fourth cerebrovascular deaths. In spite of surgical and pharmacological treatment, nearly half of the aneurysmal subarachnoid hemorrhage (SAH) patients die. Therefore, early diagnosis and prevention of IA should be a major healthcare concern in order to reduce morbidity and mortality. Etiology studies indicate that IA is related to congenital vessel wall dysplasia and acquired intracranial arterial degenerative diseases. To investigate the blood vessels of patients with IAs, we studied the aortic diameter and aortic elastic properties in IAs patients. Part I Correlation Analysis of Aortic Diameter and Intracranial AneurysmsBackgroudPrevious studies showed that the vascular wall of congenital dysplasia and acquired intracranial arterial degenerative disease are the causes of IAs. The relationship between aortic diameter and IAs remains unclear. This study was performed to assess the correlation between aortic diameter and IAs.Methods107IAs patients (57patients with hypertension) and108control subjects were recruited. The internal aortic diameters in diastole were measured by transthoracic two-dimensional echocardiography.RESULTSAortic diameter adjusted by body surface area in various echocardiographic section had no significant differences between IAs-HP, IAs-NHP and control group (P>0.05). Univariate analyses showed the aortic diameter was not associated with IAs.CONCLUSISONSThe aortic diameter was not associated with IAs. Therefore, the aortic diameter was unlikely useful in early diagnoses and prevention of IAs. Part II Aortic elastic properties and its clinical significance in IAsBackgroudIncreased large artery stiffness was an risk factor of vascular diseases. Intracranial aneurysms (IAs) occurrence is related to congenital vessel wall dysplasia and acquired intracranial arterial degenerative diseases. Therefore, the assessment of aortic mechanical properties is of particularly importance in understanding vascular disease mechanisms. This study investigated the relationship between the aortic elastic properties and IAs.Methods107IAs patients (57patients with hypertension) and108control subjects were recruited. The internal aortic diameter was measured3cm above the aortic valve during systole and diastole phases by M-mode echocardiography, and the aortic elasticity index was calculated.RESULTS①ompared to the controls, aortic distensibility was significantly decreased in IAs patients (P<0.001), while aortic stiffness index was significantly increased in IAs (P<0.001). ②ompared to the patients with IAs who did not have hypertension(IAs-NHP), aortic distensibility was significantly decreased in patients with hypertensive IAs (IAs-HP)(P<0.001), while aortic stiffness index was significantly increased (P<0.001). Similar results were obtained when the aortic elasticity index was adjusted for body surface area and body mass index.CONCLUSIONSIAs appears to correlate with abnormal aortic elasticity, and hypertension is closely related to the severity of aortic elasticity. Therefore, Abnormal aortic elasticity assessed by non-invasive ultrasound is helpful in the diagnosis and prognosis of IAs.更多还原