颈动脉内-中膜厚度和斑块对颅内动脉狭窄严重程度的预测价值  

Usefulness of carotid intima media thickness and plaques for predicting the severity of intracerebral artery stenosis

作　　者：李瑶宣[1] 李吕力[1] 钟维章[1] 王小燕[2] 宁加玲[3] 董艳玲[1] 薛富英[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：《中国神经精神疾病杂志》2010年第4期201-204,共4页Chinese Journal of Nervous and Mental Diseases

基　　金：广西壮族自治区卫生厅研究项目(编号:Z2008053)

摘　　要：目的观察缺血性脑血管病(ischemic cerebrovascular disease,ICVD)患者颈动脉内-中膜厚度(com-mon carotid intima media thickness,CCA-IMT)和斑块与颅内动脉狭窄程度的相关性,评价其对颅内动脉狭窄严重程度的预测价值。方法对151例ICVD患者行数字减影全脑血管造影(digital subtraction angiography,DSA),根据DSA结果将患者分为颅内动脉正常、轻、中、重度狭窄组,所有患者在造影前均进行CCA-IMT、斑块检测和常规生化检测。结果中度、重度狭窄组CCA-IMT、斑块分级(carotid plaques score,CPS)较正常组及轻度狭窄组显著增高(P<0.05),正常组、轻度狭窄组间及中、重度狭窄组间CCA-IMT、CPS差异无统计学意义(P>0.05),CCA-IMT、CPS与颅内动脉狭窄程度呈正相关(P<0.01)。CCA-IMT、CPS对中度以上颅内动脉狭窄预测价值的ROC曲线下面积分别为0.755、0.742,CCA-IMT≥1.2mm、CPS=3作为截断值预测中度以上颅内动脉狭窄的阳性似然比最高(分别为6·35、2·74)、有相对高的特异度(分别为93.5%、77.4%)和敏感度(分别为41.3%、62%)。Logistic回归分析显示,在调整了糖尿病、收缩压、舒张压的影响后,CCA-IMT≥1.2mm、CPS=3预测中度以上颅内动脉狭窄的比值比分别为5.603、3.427。结论CCA-IMT、CPS与颅内动脉狭窄程度呈正相关,CCA-IMT≥1.2mm、CPS=3对中度以上颅内动脉狭窄有一定的预测价值。Objective To investigate the correlation between carotid intima media thickness （CCA-IMT）and carotid plaques,and the extent of intracerebral artery stenosis,and to evaluate the usefulness of CCA-IMT and plaques for predicting the extent of intracerebral artery stenosis in ischemic cerebrovascular disease （ICVD） patients.Methods One hundred fifty-one patients with ICVD were divided into three groups based on their Digital Subtraction Angiography （DSA） features：normal group,slight,moderate to severe intracerebral artery stenosis group.CCA-IMT,plaques and regular biochemical parameters were examined in all patients.Results Compared with normal and slight intracerebral arterystenosis groups,CCA-IMT and CPS significantly increased in the patients in modrate to severe intracerebral artery stenosis groups （P0.05～0.01）.The differences in CCA-IMT and CPS were not significantly different between normal and slight intracerebral artery stenosis,moderate to severe intracerebral artery stenosis groups （P0.05）.Both CCA-IMT and CPS were strongly correlated to intracerebral artery stenosis （P0.01）.The CCA-IMT and CPS corresponding area under the ROC curve of moderate to severe stenosis were 0.755 and 0.742.CCA-IMT≥1.2 mm and CPS =3 had highest positive likelihood ratio of 6.35 and 2.74,high specificity of 93.5% and 77.4%,and a sensitivity of 41.3% and of 62% in predicting the presence of moderate to severe intracerebral artery stenosis.Logistic regression analysis revealed that CCA-IMT≥1.2 mm and CPS=3 were significant predictors for moderate to severe intracerebral artery stenosis with a odds ratio of 5.603 and 3.427 respectively.Conclusions Both CCA-IMT and CPS correlate to intracerebral artery stenosis.CCA-IMT≥1.2 mm and CPS=3 may have value for predicting moderate to severe intracerebral artery stenosis.

关 键 词：缺血性脑血管病 颈动脉疾病 颅内动脉狭窄 脑血管造影 

分 类 号：R743.3[医药卫生—神经病学与精神病学]