| Objective:Vertebrobasilar dolichoectasia(VBD) is a kind of cerebrovascular abnormalities disease characterized by significantly prolonged, twisted or extended of the vertebral- basilar artery.Ever think the incidence of the disease is relatively low, but recently, It’s found that the number of VBD patients is so large that more attention is needed to pay.We aim to improve the knowledge of VBD, probe into its pathogenesis, prevention, diagnosis and treatment methods, eventually achieve systematic and comprehensive understanding of this disease by evaluating the clinical features,influence factors and imaging features in patients with VBD.Methods:We consecutively collected 43 patients with VBD from the neurology department of the 2nd Hospital affiliated to Hebei Medical University(admission from June 2014 to October 2014), as the case group, namely VBD group. 40 patients with non VBD are randomly selected from the same period in hospital, as control group.We retrospectively analyse the influencing factors(gender, age, medical history, history of smoking, drinking, etc.),laboratory indexes(blood lipids,homocysteine),clinical manifestations, imaging characteristics,Analyse whether there is a difference between the two groups, and compare different blood type within the VBD group.We used SPSS 13.0 statistical analysis software. The measurement data were analyzed by Two-sample t-test, while the numeration data were analyzed by chi-square test, P<0.05 for the difference was statistically significant.Results: 1 General parameters: 1.1 Sex and age(Uncontrollable factors): in the 43 case group, 29 cases(67.4%) were male, the average age was 61.18±11.40; In the 40 control group, 28 cases(70%) were male, the average age was 55.70±13.65 There was no statistical difference between two groups(P>0.05).In the case group, 4 cases were under the age of 50 patients(8%), 50 patients over the age of 39 cases(92%), pesenting obvious aging trend. 1.2 Other affecting factors(controllable factors): There was no significant difference in smoking history, medical history(heart disease, diabetes, cerebral infarction, cerebral infarction, cerebral hemorrhage)between the two groups(P>0.05).Drinking history between the two groups are statistically significant(P=0.027<0.05), the VBD group has high drinking rate. 2 Comparison of laboratory indicators: Patients on admission were measured fasting plasma triglyceride, total cholesterol, low-density lipoprotein cholesterol(ldl-c), there was no significant difference in hyperlipidemia between the two groups(P>0.05).However,the incidence of hyperhomocysteinemia was significantly higher than in the non VBD group(P=0.039<0.05). 3 Clinical manifestations:In the 43 cases group, diagnosis of posterior circulation ischemia(PCI)is 32(74.4%) and is 15(37.5%)in control group of 40 cases,which is statistically significant(P=0.001<0.05),suggest VBD is closely associated with PCI.Analysis the clinical manifestation of 43 patients with VBD,the main symptoms are limb weakness(51.2%), dizziness(39.5%) and glossolalia(23.3%). 4 Imaging feature 4.1 Infarction type:Within the case group and control group in patients with PCI, we divided them into posterior circulation TIA group(without responsibility lesions) and posterior circulation infarction(POCI) group(with responsibility lesions)according to the imaging characteristics.Comparing the two groups, POCI incidence is not different(P=0.814>0.05), illustrate VBD is associated with PCI, and can also cause TIA and infarction, the occurrence is not special. 4.2 Vertebral artery dominance:Cases in the group of 43 patients with VBD, 20 patients belongs to left vertebral dominance,13 patients right vertebral dominance and 10 patients with both vertebral balance.No statistical vertebral artery dominance in control group. As is researched,the left vertebral dominance,right vertebral dominance,both vertebral balance ratio is 2:1:1.And in this case, the basic data is consistent. 4.3 The type of blood vessels 4.3.1 According to the imaging characteristics of the VBD group, circuity group, expansion and extension group are divided.In patients with VBD, circuity group has the biggest number--23 cases(53.5%),expansion group has the smallest--4 cases(9.3%),1 patients only presented with cranial nerve compression contained.It follows: expansion of patients are more prone to cranial nerve compression symptoms, and cranial nerve defect symptoms are heavier(NIHSS score >7);And the symptoms of patients with vertebral basilar artery circuity are relatively lighter, most performance for dizziness and mild nerve function defect(NIHSS score <3). 4.3.2 According to the involving parts, involvement of vertebral artery? invlvement of basilar artery and the both are divided.33 cases in the whole VBD patients involved vertebral artery,only 6 cases involved basilar artery and 4 cases the both did.Vertebral artery has a large amount of variation,considering associated with vertebral basilar artery anatomical features.On the one hand, there exists more congenital anatomic variation in vertebral artery,the other hand, compared with basal artery,vertebral artery are more easily affected by various acquired factors. 4.3.3 According to the vertebral artery form,we divided it into simplex type and straddles type.In the cases group,36 patients belong to vertebral artery simplex type(83.7%),and straddles type is 7 cases(16.3%), accounting for 16.3% of all patients with VBD, including 1 case with trigeminal nerve compression symptoms,considering associated with the straddle of vertebral artery. 4.4 Distortion of the internal carotid artery system:in the VBD group, distortion of the carotid artery system was observed in 16 cases(37.2%), while 4 cases(10%) in the control group. There was statistical difference between the two groups(P=0.022<0.05).It suggests the incidence rate of VBD patients accompanied by internal carotid artery distortion is higher.Conclusions:1 Compared with the non VBD group, VBD group has no difference in the age and sex structure, medical history(including cerebral infarction, cerebral hemorrhage, hypertension, diabetes, coronary heart disease),meaningful difference exists in alcohol intake.Patients with VBD drinking rate is higher than patients with non VBD, speculated that alcohol may be a risk factor for VBD occurred.2 Compared with the VBD group,non VBD group has significantly higher incidence of homocysteine levels,so hyperhomocysteinemia may be a risk factor for VBD.3 VBD group compared with non VBD group, the incidence of PCI is higher, VBD may be associated with PCI.4 Circuity group had the greatest incidence from the view of imaging characteristics;From the point of involvement of vascular area, the incidence of vertebral artery involved was higher,and vertebral artery dominance conditions may result in basilar artery anomalies;Serious vertebral artery circuity could result in straddles phenomenon, cranial nerve compression may easily occur.5 The proportion of VBD patients with internal carotid artery circuity was significantly higher than non VBD group, VBD is likely to be part of the expansion and circuity of intracranial artery disease. |
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