Wang Chenyang, Roberts Kenneth B, Bindra Ranjit S, Chiang Veronica L, Yu James B
Yale School of Medicine, New Haven, Connecticut.
Yale School of Medicine, New Haven, Connecticut; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
Pediatr Neurol. 2014 Jun;50(6):549-56. doi: 10.1016/j.pediatrneurol.2013.09.018. Epub 2014 Jan 25.
Radiation-induced cerebrovascular injury is a well-known phenomenon. We analyze reported cases of delayed radiation-induced cerebrovasculopathy that present as moyamoya syndrome and/or intracerebral hemorrhage and to statistically analyze the relationship between radiation dose and the interval period between radiation and the presentation of cerebrovasculopathy.
Patients ages <21 years at the time of radiation were included in analysis. A review of previous publications yielded 77 cases of delayed radiation-induced cerebrovasculopathy consisting of 45 cases of moyamoya syndrome, 30 cases of intracerebral hemorrhage, and two cases of both.
The median age at radiation was 4.8 years, with a range of 0.5-20 years. Approximately, 75% of these patients received radiation at the age of <9 years. The median interval period for moyamoya cases was 3.3 years (range: 0.3-20; P < 0.001), whereas the median interval period from radiation to presentation for intracerebral hemorrhage cases was 7.5 years (range: 0.8-27). There was significant association between radiation dose and interval from radiation to moyamoya syndrome (P < 0.001), whereas for patients with intracerebral hemorrhage, the association was insignificant (P = 0.31).
Pediatric patients who presented with moyamoya generally presented earlier than those who presented with intracerebral hemorrhage, suggesting that moyamoya may be a factor that predisposes the patient to intracerebral hemorrhage. In patients who presented with moyamoya, there was a statistically significant correlation between increasing doses of radiation and shorter time from radiation to disease presentation.
辐射诱发的脑血管损伤是一种众所周知的现象。我们分析报告的表现为烟雾病综合征和/或脑出血的迟发性辐射诱发脑血管病病例，并对辐射剂量与辐射至脑血管病出现的间隔时间之间的关系进行统计分析。
分析辐射时年龄小于21岁的患者。回顾先前的出版物，得到77例迟发性辐射诱发脑血管病病例，其中烟雾病综合征45例，脑出血30例，两者兼具2例。
辐射时的中位年龄为4.8岁，范围为0.5 - 20岁。这些患者中约75%在9岁之前接受了辐射。烟雾病病例的中位间隔时间为3.3年（范围：0.3 - 20；P < 0.001），而脑出血病例从辐射到出现症状的中位间隔时间为7.5年（范围：0.8 - 27）。辐射剂量与从辐射到烟雾病综合征的间隔时间之间存在显著关联（P < 0.001），而对于脑出血患者，这种关联不显著（P = 0.31）。
出现烟雾病的儿科患者通常比出现脑出血的患者出现症状更早，这表明烟雾病可能是使患者易患脑出血的一个因素。在出现烟雾病的患者中，辐射剂量增加与从辐射到疾病出现的时间缩短之间存在统计学上的显著相关性。
