肱动脉内皮功能对颅内动脉狭窄的预测价值  

Evaluation of brachial artery endothelial function in predicting the extent of intracerebral artery stenosis

作　　者：李瑶宣[1] 钟维章[1] 赵毅兰[2] 宁加玲[3] 董艳玲[1] 薛富英[1] 李吕力[1] 

机构地区：[1]广西壮族自治区人民医院神经科,南宁530021 [2]广西壮族自治区人民医院超声科 [3]广西壮族自治区人民医院病案管理科统计室

出　　处：《陕西医学杂志》2010年第4期416-419,共4页Shaanxi Medical Journal

基　　金：广西壮族自治区卫生厅研究项目(NO.Z2008053)

摘　　要：目的:探讨缺血性脑血管病患者肱动脉血流介导的血管扩张(FMD)及非内皮依赖性舒张(NMD)与颅内动脉狭窄程度的相关性,评价FMD和NMD对颅内动脉狭窄程度的预测价值。方法:对100例缺血性脑血管病患者行数字减影全脑血管造影(DSA),根据DSA结果将患者分为4组,即颅内动脉正常,轻、中、重度狭窄组,对各组的FMD、NMD水平进行分析。结果:颅内动脉正常组21例,轻、中、重度狭窄组分别为25例、21例、33例,4组FMD分别为:7.79%±2.51%、4.96%±1.43%、5.00%±1.56%、5.02%±2.15%;NMD分别为14.31%±6.76%、12.54%±5.40%、16.52%±4.79%、13.27%±9.22%;与正常组比较,颅内动脉轻、中、重度狭窄组FMD显著降低(P<0.01),轻、中、重度狭窄组之间FMD差异无统计学意义(P>0.05);4组间NMD比较差异无统计学意义(P>0.05)。FMD对颅内动脉狭窄预测价值的受试者工作特征曲线下面积为0.751±0.061(95%可信区间为:0.630-0.871,P=0.000),FMD≤4%作为截断值预测颅内动脉狭窄时,阳性似然比最高(3.33),特异度为90.5%、灵敏度为31.6%。Logisticd回归分析显示,在调整了收缩压、舒张压的影响后,FMD≤4%预测颅内动脉狭窄的比值比为(OR)为4.923。结论:FMD≤4%是颅内动脉狭窄的独立预测因子,对颅内动脉狭窄有中等预测价值,但不能评价颅内血管狭窄的程度。Objective：To observe the correlation among flow-mediated dilatation（FMD）,nitroglycerin-mediated dilation（NMD）in the brachial artery and the extent of intracerebral artery stenosis, and to evaluate the usefulness of FMD and NMD in predicting the extent of intracerebral artery stenosis in ischemic cerebrovascular disease patients. Methods： By the Digital Subtraction Angiography（DSA）,the 100 patients with ischemic cerebrovascular disease were divided into 4 groups. The FMD and NMD in the brachial artery and regular biochemical parameters were detected in each group. Results： According to DSA, the patients were divided into normal group（21cases）, slight, midrange and severe intracerebral artery stenosis groups（25cases,21cases and 33cases respectively）.The FMD of the consecutive groups were ： 7.79±2.51%、4.96±1.43%、5.00±1.56%、5.02±2.15% ; the NMD were 14.31±6.76%,12.54±5.40%,16.52±4.79%and13.27±9.22% ;respectively.Compared with normal group ,the FMD were significantly lower in the slight , midrange and severe intracerebral artery stenosis groups （P0.01）.There was no significant difference of FMD among the patients with slight ,midrange and severe intracerebral artery stenosis（P0.05） ;there was no significantly difference of NMD among the 4 groups. FMD corresponding area under the ROC curve of intracerebral artery stenosis were 0.751±0.061, with 95% confidence interval （CI） 0.630 to 0.871 （P= 0.000）.FMD≤4% was associated with a specificity of 90.5% and a sensitivity of 31.6% and a positive likelihood ratio of 3.33 in predicting the presence of intracerebral artery stenosis.Logistic regression analysis revealed that after adjusting systolic pressure and diastolic pressure, FMD≤4% was a predictor for intracerebral artery stenosis with a odds ratio（OR） of 4.923 .Conclusion： FMD≤4% was predictor for intracerebral artery stenosis .It has moderate value in predicting the presence of intracerebral artery stenosis,but can not predict the degree of intracereb

关 键 词：脑血管障碍 预测 肱动脉 内皮 血管 

分 类 号：R734[医药卫生—肿瘤]