1.中南大学湘雅医院 神经外科;2.湖南省儿童医院 神经外科,;3.湖南省儿童医院 神经外科;4.常德市第一人民医院;5.神经外科
受到湖南省科技重大专项（项目编号：2020SK1012）资助。
- Dong Tang 1
- Zheng Huang 1
- Wei Ding 2,3,4
- Shuihua Wu 2,3,4
- Hua Chen 5,3,6
- Junyu Wang 1
- Fenghua Chen 1
1.Department of Neurosurgery,Xiangya Hospital,Central South University,Changsha;2.Department of Neurosurgery,Hunan Children'3.'4.s Hospital,Changsha;5.Department of Neurosurgery,The first people'6.s Hospital changde city
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目的 脑血运重建术是缺血型烟雾病的主要治疗方式,但手术治疗的疗效有一定争议,我们开展多中心回顾性研究以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 本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名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危险因素。结果 462例烟雾病患者平均随访时间为33.6个月,对于242例手术治疗和220例保守治疗患者,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曲线分析显示新发脑卒中发生存在显著差异(Log rank,P=0.018)；多因素COX生存分析提示后循环受累(HR 5.162,95% CI 2.343-11.375; P<0.001)和脑白质病变(HR 2.287,95% 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,不同手术方式对降低脑卒中再发生无显著差异。
Objective Surgical revascularization is the main treatment for ischemic type moyamoya disease (MMD), but the efficacy for stroke prevention and prognosis is still controversial. A multicenter retrospective study was performed to investigate the efficacy of surgical treatment. Methods Clinical, neuroradiologic and follow-up data of 462 patients with ischemic type MMD disease 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 used to generate matched pairs based on age, sex, factors associated with stroke, cerebral infarction, white matter hyperintensities, Suzuki stages, bilateral MMD, posterior cerebral artery involvement, associated aneurysm. Kaplan-Meier curve was used to compare the recurrence rate of stroke between surgical and conservative treatment. Multifactorial Cox regression analyses were carried out to find the risk factors for recurrent stroke in patients with surgical treatment. Results The mean follow-up duration was 33.6 months. Thirty-one (12.8%) patients had new stroke in 242 surgically treated patients and 63 (28.6%) patients had new stroke in 220 conservatively treated patients, respectively. By one-to-one propensity score matching, 185 pairs were selected. Kaplan-Meier curve suggested a significant difference in the incidence of recurrent stroke (Log rank, P=0.018). Multivariable Cox regression analysis revealed posterior cerebral artery involvement (HR 5.162, 95% CI 2.343-11.375; P<0.001) and cerebral white matter hyperintensities (HR 2.287, 95% CI 1.083-4.828; P=0.030) were risk factors for recurrent stroke after surgery. There was no difference between the two surgical procedures (combined and indirect revascularization) for 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 disease, and different surgical procedures are both effective.
