颅内外大动脉无狭窄患者发生后循环梗死的血管反应性评估  

Assessment of CVR in patients with posterior circulation infarction but without intra-and extracranial conducting artery stenosis

作　　者：李壮丽[1] 杨昉[1] 孔丽[1] 蓝文雅[1] 白文[1] 胡静泽[1] 黄志新[1] 刘玲[1] 张仁良[1] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)神经内科,210002

出　　处：《中华老年心脑血管病杂志》2014年第4期404-406,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81070923);江苏省自然科学基金(BK2011663)

摘　　要：目的通过对患者大脑中动脉血管反应性(CVR)与椎动脉CVR的比较,评估颅内外大动脉无狭窄但发生后循环梗死(PCI)患者CVR,探讨前后循环血流动力学变化在预测PCI发生中的作用。方法选择PCI患者27例(PCI组),选择同期健康体检者25例(对照组)。采用经颅多普勒超声结合CO2吸入试验检测所有入选患者的大脑中动脉CVR和椎动脉CVR。结果与对照组比较,PCI组左侧和右侧大脑中动脉CVR明显下降[(25.96±15.90)%vs(34.63±8.60)%,(26.40±14.54)%vs(34.49±9.08)%,P<0.05];PCI组椎动脉CVR较对照组有下降,但差异无统计学意义(P>0.05)。多变量线性回归分析显示,糖尿病是大脑中动脉CVR受损的独立危险因素(β=-0.116,P=0.035)。结论大脑中动脉CVR下降,而非椎动脉CVR下降,可作为颅内外大动脉无狭窄患者发生PCI预测指标。对于颅内外大动脉无明显狭窄的患者,糖尿病是大脑中动脉CVR降低的独立危险因素。Objective To assess the cerebrovascular reactivity （CVR） in patients with posterior cir- culation infarction（PCI） but without intra- and extracranial conducting artery stenosis. Methods Twenty-seven PCI patients served as a PCI group and 25 subjects undergoing physical examina- tion served as a control group in this study. The CVR in middle cerebral artery （MCA） and verte- bral artery （VA） was detected by transcranial Doppler uhrasonography combined with CO2 inha- lation test. Results The CVR in left and right MCA was significantly lower in PCI group than in control group （25.96±15.90）%vs（34.63±8.60）%,（26.40±14.54）%vs（34.49±9.08）%,P〈0.05）. No significant difference was found in CVR between the two groups although it was higher in PCI group than in control group （P 〉 0. 05）. Multivariate linear regression analysis showed that diabetes was the independent risk factor for CVR in MCA （β=-0. 116 ,P=0. 035）. Conclusion Reduced CVR in MCA rather than CVR in VA can be used as an independent predic- tor of PCI. Diabetes is an independent risk factor for reduced CRV in MCA of patients without in- tra- and extracranial conducting artery stenosis.

关 键 词：梗死 大脑中动脉 血流动力学 椎动脉 糖尿病 超声检查 多普勒 经颅 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]