Analysis Of Adult Moyamoya Disease Related Risk Factors And Relationship Between Vascular Bypass And Its Prognosis

Objective Analysis of sex, age distribution,etiology and clinical features of adult moyamoya disease(MMD) to investigate the risk factors of ischemic and hemorrhagic events for adult patients with moyamoya.And compare vascular bypass group and non vascular bypass effect in preventing recurrence cerebral hemorrhage, aims to deepen the understanding of moyamoya disease, provide the basis for a prospective study.Methods Collected from February 2014 to February 2015 in nanchang university first affiliated hospital of 211 cases of adult patients with moyamoya disease.A detailed record of every hospital patients age, gender, past medical history, personal history,imaging data, follow-up and treatment process.According to the clinical manifestations and imaging examination is divided into 37 cases of cerebral infarction group(including TIA) and 148 cases of cerebral hemorrhage group.According to the follow-up and treatment into 32 cases of the vascular bypass group and 98 cases of non vascular bypass group.Compare two groups of age, sex,hypertension,diabetes,hyperhomocysteinemia(HHCY),smoking,high cholesterol and brain aneurysm of the cerebral infarction group and cerebral hemorrhage group. The effect factors of moyamoya disease lead to stroke events further using multiariable Logistic regression analysis.Compare vascular bypass group and non vascular bypass in the prevention of bleeding events in MMD.Results(1)We identified 211 adults with moyamoya disease who met our inclusion criteria. 96 cases of male,and 115 cases of female,male to female ratio is about 1:1.20.The mean age of 47.06±10.15.(2)The common parts of the cerebral hemorrhage is ventricle,beside the ventricle,lobes and subarachnoid space.The common parts of the cerebral infarction is lobes and beside the ventricle.(3)In an average of 6.3 monthsfollow-up period, 6 patients recurrence of bleeding in the brain of 193 cases. 32 cases of cerebral hemorrhage MMD patients in bypass surgery,1 case of recurrence cerebral hemorrhage, rebleeding ratio is 3.13%(1/32), lower than the non-bypass group of blood MMD rebleeding proportion is 5.10%(5/98), but P> 0.05,there was no statistically significant.(4)It is find that HHCY and brain aneurysm was statistically significant between cerebral hemorrhage group and cerebral infarction group from single factor analysis.Two groups of gender, age, hypertension, high cholesterol,diabetes and smoking was no statistically significant. Multivariate Logistic regression analysis showed that MMD with cerebral aneurysm is prone to hemorrhagic events,and combined with high blood homocysteine are prone to ischemic events.Conclusion(1)The adult patients with moyamoya disease predominantly middle-aged women.(2)Adult patients with MMD most presented with hemorrhagic events.The common parts of the cerebral hemorrhage is ventricle,beside the ventricle,lobes and subarachnoid space.The common parts of the cerebral infarction is lobes and beside the ventricle.(3)Moyamoya disease with cerebral aneurysm is prone to produce hemorrhagic events, and combined with high blood homocysteine are prone to ischemic events.(4)The role of revascularization therapy in MMD has a tendency to reduce recurrence cerebral hemorrhage.