成人烟雾病颞浅动脉-大脑中动脉搭桥术后出血性高灌注综合征的临床特点及危险因素分析OA
Clinical features and risk factors of hyperperfusion hemorrhage after STA-MCA bypass in adult moyamoya disease
目的 探讨成人烟雾病行颞浅动脉-大脑中动脉搭桥(STA-MCA)术后高灌注出血的临床特点及危险因素.方法 回顾性分析2017 年11 月—2025 年5 月南京医科大学附属脑科医院采用STA-MCA 搭桥治疗的382 例成人烟雾病临床资料.根据术后 2 周是否出现出血性高灌注综合征(hCHS),分为 hCHS 组和非 hCHS 组.采用改良 Rankin 量表评分(mRS)评估患者术后半年临床预后.单因素分析和多因素 Logistic回归模型探索烟雾病患者搭桥术后 hCHS 的危险因素.结果 382 例患者中,18 例患者出现 hCHS,其中单纯蛛网膜下腔出血4 例(含术中1 例),单纯脑出血11 例,蛛网膜下腔出血合并脑出血3 例.术后半年 mRS 0～2 分361 例,3～6 分21 例.随访 hCHS 组 mRS 为 2.5(1,3.25)分,其中 0～2 分占 50%(9/18);非 hCHS 组mRS 为1(0,1)分,其中0～2 分占96.70%(352/364),两组 mRS 分布差异具有统计学意义(Z=-4.691,P<0.001).单因素分析结果显示,hCHS 组和非 hCHS 组患者的原发性高血压、首发临床表现为脑梗死、铃木分期的差异具有统计学意义.多因素 Logistic 回归结果显示,原发性高血压(OR=3.695,95%CI=1.274～10.716;P=0.016)、首发症状为脑梗死(OR=2.995,95%CI=1.030～8.706;P=0.044)、高铃木分期(OR=1.700,95%CI=1.002～2.885;P=0.049)是成人烟雾病患者行 STA-MCA 搭桥术后 hCHS 的独立危险因素.结论 hCHS 多发生于STA-MCA 搭桥术后5d 内,远期预后显著差于非hCHS 者.原发性高血压、首发临床表现为脑梗死、高铃木分期的成人烟雾病患者行 STA-MCA 搭桥术具有更高 hCHS 风险.
Objective To investigate the clinical characteristics and risk factors of hyperperfusion-related hemorrhage after superficial temporal artery-middle cerebral artery(STA-MCA)bypass in adult patients with Moyamoya disease(MMD).Methods The clinical data of 382 adult MMD patients who underwent STA-MCA bypass at Nanjing Brain Hospital from November 2017 to May 2025 were analyzed retrospectively.Patients were divided into the hemorrhagic cerebral hyperperfusion syndrome(hCHS)group and the non-hCHS group,based on the occurrence of hCHS within 2 weeks after surgery.The modified Rankin scale(mRS)was used to evaluate the clinical prognosis of patients half a year postoperatively.Univariate analysis and multivariate Logistic regression models were applied to identify the risk factors for postoperative hCHS in MMD patients.Results Among the 382 patients,18 developed hCHS,including 4 cases of subarachnoid hemorrhage(one occurring intraoperatively),11 cases of intracerebral hemorrhage(ICH),and 3 cases of combined SAH and ICH.Half a year after surgery,361 patients had an mRS score of 0-2,while 21 had a score of 3-6.The mRS score was 2.5(1,3.25)in the hCHS group,with 50%(9/18)of patients achieving an mRS score of 0～2.In the non-hCHS group,the mRS score was 1(0,1),with 96.70%(352/364)of patients having an mRS score of 0-2.There was a statistically significant difference in the mRS distribution between the two groups(Z=-4.691,P<0.001).Univariate analysis showed that the two groups differed significantly in terms of essential hypertension,the initial clinical presentation of cerebral infarction,and Suzuki stage.Multivariate Logistic regression analysis revealed that essential hypertension(OR=3.695,95%CI=1.274-10.716,P=0.016),initial symptom of cerebral infarction(OR=2.995,95%CI=1.030-8.706,P=0.044)and high Suzuki stage(OR=1.700,95%CI=1.002-2.885,P=0.049)were independent risk factors for hCHS after STA-MCA bypass in adult MMD patients.Conclusions hCHS mostly occurs within one week after STA-MCA bypass,and the prognosis of patients with hCHS is significantly worse than that of non-hCHS patients.Adult MMD patients with essential hypertension,initial clinical presentation of cerebral infarction or advanced Suzuki stage have a higher tendency to develop hCHS after STA-MCA bypass.
余志强;张光绪;赵金兵;陈立久;何升学
210029 南京,南京医科大学附属脑科医院脑血管病救治中心210029 南京,南京医科大学附属脑科医院脑血管病救治中心210029 南京,南京医科大学附属脑科医院脑血管病救治中心210029 南京,南京医科大学附属脑科医院脑血管病救治中心210029 南京,南京医科大学附属脑科医院脑血管病救治中心
医药卫生
烟雾病脑血管重建术出血性高灌注综合征疾病特征危险因素
moyamoya diseasecerebral revascularizationhemorrhagic cerebral hyperperfusion syndromedisease characteristicrisk factor
《临床神经外科杂志》 2026 (4)
406-411,417,7
江苏省卫生健康委医学科研项目(H2023143)
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