主动脉弓及其分支DSA临床研究

河南科技大学 硕士学位论文 主动脉弓及其分支DSA临床研究 姓名：刘建文 申请学位级别：硕士 专业：影像医学与核医学 指导教师：高万勤
20100501
摘要
论文题目：主动脉弓及其分支 DSA 临床研究 专 业： 影像医学与核医学 研 究 生： 刘建文 指导教师： 高万勤 教授
摘要
目的：回顾性分析 727 例河南患者的主动脉弓数字减影造影（DSA）的影像 资料，探讨其临床意义。对该组患者的主动脉弓及其分支变异情况、不同主动脉 弓形态类型进行统计分析，并分析各主动脉弓类型与性别、年龄、高危因素之间 的相关性。建立一个神经介入治疗数据库。
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河南科技大学硕士学位论文
originated from BCT, LSCA 4 cases; (4) LCCA and RCCA common trunk and RSCA originated from BCT, LSCA 3 cases; (5) no BCT, RCCA, LCCA, LSCA, aberrant RSCA originated from AA 3 cases; (6) common origin of BCT and LCCA, LVA, LSCA 2 cases. The other 19 variation types were 1 case, respectively. The variation type compared difference with gender had no statistically significant (P﹥0.05).
In 727 cases, type Ⅰ arch 325 cases (44.7%), type Ⅱ arch 228 cases (31.4%), type Ⅲ arch 174 cases (23.9%).In young group (≤44 years) 162 cases(22.3%), type Ⅰ～Ⅲ arch 115(15.8%), 36(5.0%), 11(1.5%). In middle-aged group（45～59 years） 256 cases(35.2%), type Ⅰ～Ⅲ arch 131(18.0%), 80(11.0%), 45(6.2%). In the elderly group（60～79 years）298 cases(41.0%), type Ⅰ～Ⅲ arch 79(10.9%), 108(14.9%), 111(15.3%). advanced age group （≥80 years）11 cases (1.5%), type Ⅰ～Ⅲ arch 0 (0%), 4(0.6%), 7(1.0%). Three kinds of AA types various age groups, the high-risk factors, hypertension, the history of coronary heart disease, the history of cerebrovascular disease and HDL the comparison difference had the obvious statistics significance (P<0.05). The AA type compared difference with gender, smoking history, history of high blood lipids, history of diabetes, family history of cardio-cerebrovascular disease, fasting blood glucose, CH, TG, LDL and the type of disease had no statistically significant (P﹥0.05). The items used Logistic analysis what comparison difference had statistics significance (P<0.05). The result showed: age groups had statistically significant, the high-risk factor, hypertension, the history of coronary heart disease, the history of cerebrovascular disease and HDL had no statistically significant.
Results: A single center neuro-intervention database was established. The normal type what usually described three branches arising at arch of aorta were observed in 609 specimens (83.8%). The variation at the major branches of aortic arch were observed in 118 case (16.2%), twenty-five variation types of the AA and its` branches were found. There were six common variation types: (1) common origin of BCT and LCCA, LSCA 65 cases; (2) BCT, LCCA, LVA, LSCA 22 cases; (3) LCCA
结论：1. Epidata 3.1 中文版：免费、易用、够用。建立了省内第一个大型的 神经介入数据库。便于对病人的随访、复查等管理。可进行一系列神经介入回顾 性研究，并为设计前瞻性研究提供参考依据。但该数据库目前还比较粗糙，文字 资料与影像资料未合一，还需进一步完善。
2. 本研究报道了 25 种主动脉弓及其分支变异类型，为国内外单中心报道主 动脉弓分支变异种类最多，为影像诊断、外科手术、介入科医生提供参考依据。
Materials and Methods: To design a database by the free database software Epidata 3.1 Chinese version of Danish, and every case medical information had been inputed.
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河南科技大学硕士学位论文
较差异有统计学意义（P<0.05）。主动脉弓类型与：性别、吸烟史、高血脂病史、 糖尿病史、心脑血管病家族史、空腹血糖、CH、TG、LDL、疾病类型之间比较 差异无统计学意义（P﹥0.05）。X2 检验有统计学意义的各项指标再应用 Logistic 统计分析，结果显示：年龄差异有明显统计学意义；而多发高危因素、高血压、 有无冠心病史、有无脑血管病史者、HDL 差异无统计学意义。
材料与方法：应用 Epidata 3.1 中文版，设计好数据库并逐份录入病历资料。 727 例资料齐全的患者，男 466 例（64.1%），女 261 例（35.9%）；年龄 14～85 岁，平均年龄 55.28 ± 13.9 岁，中位年龄 57.0 岁。参照通用的 McDonald、Anson 的分型法结合 DeGaris 的分型法统计主动脉弓及分支变异类型。主动脉弓类型以 颈总动脉直径为参照标准，按主动脉弓顶至头臂干开口的垂直距离，将主动脉弓 分为 3 型。颈总动脉直径以内者为Ⅰ型，介于 1～2 倍颈总动脉直径之内者为Ⅱ型， 超过 2 倍颈总动脉直径者为Ⅲ型。采用交叉表卡方检验，有统计学意义者再用 Logistic 检验，P<0.05 为有统计学意义。
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摘要
Subject: Clinical Study of Aortic Arch and its Branches DSA
Specialty: Medical Imaging and Nuclear medicine
Naபைடு நூலகம்e:
Liu Jian-wen
Supervisor: Professor Gao Wan-qin
结果：建立了一个单中心神经介入治疗数据库。 主动脉弓及其分支正常型 609 例 (83.8%)，变异者 118 例(16.2%)，25 种变异 类型，最常见的 6 种变异类型是：LCCA 与 BCT 共干、LSCA：65 例；BCT、LCCA、 LVA、LSCA：22 例；LCCA 发自 BCT、LSCA：4 例；LCCA、RCCA 共干与 RSCA 发自 BCT、LSCA：3 例；无 BCT、RCCA、LCCA、LSCA、迷走 RSCA 最后发 出：3 例；LCCA 与 BCT 共干、LVA、LSCA：2 例；其他 19 种类型分别为 1 例。 男女之间主动脉弓及其分支变异类型发生率比较，差异无统计学意义（P﹥0.05）。 主动脉弓 3 种类型：Ⅰ型主动脉弓 325 例，44.7%；Ⅱ型主动脉弓 228 例， 31.4%；Ⅲ型主动脉弓 174 例，23.9%。青年组（≤44 岁）162 例(22.3%)，Ⅰ型 115 例(15.8%)，Ⅱ型 36 例(5.0%)，Ⅲ型 11 例(1.5%)；中年组（45～59 岁）256 例(35.2%)， Ⅰ型 131 例(18.0%)，Ⅱ型 80 例(11.0%)， Ⅲ型 45 例(6.2%)；老年组（60～79 岁） 298 例(41.0%)，Ⅰ型 79 例(10.9%)，Ⅱ型 108 例(14.9%)， Ⅲ型 111 例(15.3%)； 高龄组（80 岁以上）11 例(1.5%)，无Ⅰ型，Ⅱ型 4 例(0.6%)， Ⅲ型 7 例(1.0%)。 3 种主动脉弓类型与各年龄组、多发高危因素、高血压之间比较差异有明显统计 学意义（P=0.000），主动脉弓类型与有无冠心病史、有无脑血管病史者、HDL 比
3. 对大于 60 岁、尤其是合并高血压、心脑血管病病史、HDL 异常等高危因 素患者应高度重视主动脉弓形态，建议对这类病人常规行主动脉弓 DSA 检查。为 国内首先报道主动脉弓 DSA 分型，各类型与各种高危因素之间关系分析。
关 键 词：主动脉弓类型，主动脉弓分支，变异，数字减影血管造影 论文类型：应用研究
The study analyzed retrospectively 727 patients, who had data integrity of AA DSA images and the medical records, male 466 cases (64.1%), female 261 cases (35.9%), age ranging from 14 to 85 years, median age 57 years, mean age 55.28±13.9 years. The AA branches variation types based on McDonald and Anson, DeGaris`s classification types. The aortic arch can be classified into three types based on the distance of the origin of the innominate artery from the top of the arch. The widest diameter of the left CCA is used as a reference unit. In a type I arch, the innominate artery originates within one diameter length from the top of the arch. In a type II arch, the innominate artery originates within two diameter lengths from the top of the arch. In a type III arch, the innominate artery originates more than two diameter lengths from the top of the arch. The information was analyzed by the cross-table Chi-square (χ2) test, then, the Logistc inspection was used for statistical significant datas, P <0.05 as statistically significant.
ABSTRACT
Object: To analyze retrospectively 727 patients` digital subtraction angiography (DSA) images of the aortic arch (AA). To analyze the variant types and incidence of the AA and its branched of Henan Province patients, to statistic the incidence of three AA types and the interrelationship of the AA types, gender, age groups and high-risk factors. To establish a Neuro-intervention therapy database.