缺血型烟雾病手术疗效的多中心研究
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1.中南大学湘雅医院神经外科,湖南 长沙 410008;2.中南大学脑血管病研究中心,湖南 长沙 410008;3.湖南省儿童医院神经外科,湖南 长沙 410007;4.常德市第一医院神经外科,湖南 常德 415003

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陈风华,中南大学湘雅医院神经外科教授、主任医师、博士研究生导师,研究方向为脑血管病的临床与基础研究,邮箱:xycfh@163.com。

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湖南省科技重大专项(2020SK1012)。


Efficacy of surgical revascularization for stroke prevention and prognosis in ischemic-type moyamoya disease: A multicenter study
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Affiliation:

1.Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China;2.Research Center for Cerebrovascular Disease, Central South University, Changsha, Hunan 410008, China;3.Department of Neurosurgery, Hunan Children’s Hospital, Changsha, Hunan 410007, China;4.Department of Neurosurgery, The First People’s Hospital of Changde City, Changde, Hunan 415003, China

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    摘要:

    目的 通过多中心回顾性研究探讨脑血运重建术及不同手术方式在预防脑卒中再发生及神经功能预后的疗效。方法 研究纳入了中南大学湘雅医院、常德市人民医院和湖南省儿童医院462例缺血型烟雾病患者的临床信息、影像学资料和随访资料,进行倾向性评分匹配后采用Kaplan-Meier曲线比较手术与保守治疗后卒中再发生的差异;多因素Cox回归分析筛选手术治疗的影响因素。结果 462例烟雾病患者平均随访时间为33.6个月,242例手术治疗和220例保守治疗患者中分别有31例(12.8%)和63例(28.6%)新发脑卒中,进行倾向性评分匹配后,185例手术治疗和185例保守治疗患者纳入进一步分析。Kaplan-Meier曲线分析显示两者新发脑卒中发生存在差异(P=0.018);多因素Cox生存分析提示后循环受累(95% CI:2.343~11.375, P<0.001)和脑白质病变(95% CI:1.083~4.828, P=0.030)是手术后卒中再发的危险因素,两种手术方式(联合和间接血运重建术)在卒中再发生预防方面无统计学差异(P=0.777)。结论 与保守治疗相比,手术能降低缺血型烟雾病卒中再发生的风险和取得良好预后,不同手术方式对防止脑卒中再发生无差异。

    Abstract:

    Objective To investigate the efficacy of cerebral revascularization (different surgical procedures) for stroke prevention and prognosis in ischemic-type moyamoya disease (MMD) through a multicenter retrospective study.Methods Clinical, neuroradiologic, and follow-up data of 462 patients with ischemic-type MMD from Xiangya Hospital of Central South University, Changde People’s Hospital, and Hunan Children’s Hospital were analyzed in this study. Propensity score matching was performed, and then the Kaplan-Meier curve was used to compare the recurrence rate of stroke between the patients receiving surgical treatment and those receiving conservative treatment. A multivariable Cox regression analysis was performed to identify the risk factors for stroke recurrence after surgical treatment.Results The mean follow-up time was 33.6 months in the 462 patients. Stroke occurred in 31 (12.8%) of the 242 surgically treated patients and 63 (28.6%) of the 220 conservatively treated patients. A total of 185 pairs were selected through propensity score matching. The Kaplan-Meier curve showed a significant difference in the incidence of recurrent stroke between the two groups (P=0.018). The multivariable Cox regression analysis revealed that posterior cerebral artery involvement (95% confidence interval [CI]: 2.343-11.375, P<0.001) and cerebral white matter hyperintensities (95% CI: 1.083-4.828, P=0.030) were risk factors for stroke recurrence after surgery. There was no significant difference between the two surgical procedures (combined and indirect revascularization) in the prevention of recurrent stroke (P=0.777).Conclusions Compared with conservative treatment, surgical revascularization can reduce the incidence of recurrent stroke and achieve favorable outcome in ischemic-type MMD, and different surgical procedures are similar in preventing recurrent stroke.

    表 1 462例缺血型MMD患者基线特征 例(%)Table 1
    表 4 缺血型烟雾病手术治疗后脑卒中发生的危险因素分析Table 4
    表 5 缺血型烟雾病手术与保守治疗疗效比较的文献汇总Table 5
    图1 缺血型烟雾病保守治疗与手术治疗组脑卒中再发的Kaplan-Meier曲线Fig.1
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    表 2 缺血型烟雾病手术治疗与保守治疗PSM前后基线特征Table 2
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汤东,黄正,丁威,吴水华,陈华,王君宇,陈风华456.缺血型烟雾病手术疗效的多中心研究[J].国际神经病学神经外科学杂志,2024,(2):23-28111TANG Dong, HUANG Zheng, DING Wei, WU Shuihua, CHEN Hua, WANG Junyu, CHEN Fenghua222. Efficacy of surgical revascularization for stroke prevention and prognosis in ischemic-type moyamoya disease: A multicenter study[J]. Journal of International Neurology and Neurosurgery,2024,(2):23-28

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  • 收稿日期:2023-12-05
  • 最后修改日期:2024-04-10
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  • 在线发布日期: 2024-06-19
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