缺血性脑卒中的脑血流动力学变化与糖脂代谢紊乱的相关性  

Correlation analysis of cerebral hemodynamics of trancranial Doppler and hyperglycemia and dyslipidemia in ischemic stroke

作　　者：陈雅玲[1] 傅建辉[1] 韩翔[1] 方堃[1] 陈淑芬[1] 董强[1] 

机构地区：[1]复旦大学附属华山医院神经内科,上海200040

出　　处：《上海医学》2009年第4期299-303,共5页Shanghai Medical Journal

摘　　要：目的采用经颅多普勒超声(TCD)检查评估缺血性脑卒中患者的脑血流动力学,探讨其与缺血性脑卒中患者糖脂代谢紊乱之间的相关性。方法67例缺血性脑卒中患者入院次日测定空腹血糖、血脂,并行TCD检查记录颅内大动脉的收缩期(Vs)、舒张期(Vd)、平均血流速度(Vm)、搏动指数(PI)及阻力指数(RI),确定是否建立侧支循环;按数字减影血管造影(DSA)或TCD结合计算机断层摄影血管造影(CTA)血管成像是否存在血管狭窄分组,分析血管狭窄、侧支循环以及血流速度、PI与糖脂代谢紊乱的相关性。结果颅内血管狭窄的发生与低密度脂蛋白(r=0.252)、空腹血糖(r=0.288)呈正相关(P值均<0.05),Logistic回归分析显示,既往有糖尿病史是缺血性脑卒中患者发生血管狭窄的独立危险因素(OR=2.106,P=0.041)。颅内侧支循环的建立与糖脂代谢紊乱不相关(P>0.05)。多元线性回归显示,大脑中动脉的PI与空腹血糖呈正相关(OR=0.016,P=0.037),而血流速度与糖脂代谢紊乱不相关(P>0.05)。结论缺血性脑卒中患者血管狭窄及PI与糖脂代谢紊乱存在相关性,但仍需大样本临床研究的证实。Objective To explore the association of transcranial Doppler hemodynamic parameters with hyperglycemia and dyslipidemia in ischemic stroke patients. Methods Sixty-seven consecutively ischemic stroke patients recruited in Neurology Department of Huashan Hospital underwent fast blood glucose （FBG）, serum lipid level examination and transcranial Doppler ultrasonography. hemodynamic parameters such as the mean velocity （Vm）, peak systolic velocity （Vs）, end diastolic velocity （Vd） and pulsatility index （PI） were recorded. Intracranial stenosis and collateral circulation were determined with the aid of digital substraction angiography （DSA） or computed tomographic angiography iOTA）. The SPSS 12. 0 was used to analyze the correlation between cerebral hemodynamics and hyperglycemia and dyslipidemia. Results Intracranial stenosis was significantly correlated with serum low-density lipoprotein （LDL） and FBG （r = 0. 252, P〈0. 05; r = 0. 288, P〈0. 05）. Logistic analysis showed that diabetes history was an independent risk factor for intracranial stenosis （OR = 2. 106, P = 0. 041）. Collateral circulation showed no significant correlation with hyperglycemia and dyslipidemia （ P〉0. 05）. The elevated FBG independently predicted the high PI of middle cerebral artery （OR = 0. 016, P = 0. 037）, while flow velocity of blood showed weak correlation with hyperglecemia and dyslipidemia （P〉0. 05）. Conclusion Cerebral hemodynamics（intracranial stenosis and PI） is correlated with hyperglycemia and dyslipidemia, although larger cohort study is needed to further confirm our conclusion.

关 键 词：经颅多普勒 颅内血管狭窄 侧支循环 血流动力学 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R587.1[医药卫生—临床医学]