血流动力学对颅内动脉粥样硬化性狭窄的计算机数值模拟研究  

Numerical study of hemodynamic factors in computational fluid dynamic modeling of intracranial artery atherosclerotic stenosis

作　　者：沈雷[1] 张永巍[1] 吕楠[1] 黄清海[1] 邓本强[1] 

机构地区：[1]第二军医大学附属长海医院脑血管病中心,上海200433

出　　处：《中华神经科杂志》2016年第3期222-226,共5页Chinese Journal of Neurology

基　　金：上海市科学技术委员会科研计划项目（124119a9800）;第二军医大学优秀硕士生苗子培育基金资助项目

摘　　要：目的探讨血流动力学在颅内动脉粥样硬化性狭窄患者中的作用。方法回顾性分析18例局限性大脑中动脉水平段狭窄的患者，按患者临床症状和磁共振检查结果将患者分为症状组（n=13）与非症状组（n=5）。依据3D脑血管造影建立病例特异性计算机血流动力学数值模型，评估两组间狭窄局部壁面剪切力、震荡剪切力、流速及管壁压力等血流动力学参数差异，并探索影响症状性颅内动脉粥样狭窄血流动力学变化的相关危险因素。结果两组间年龄、性别、狭窄程度、平均动脉压及高血压病、糖尿病病史等差异均无明显统计学意义。血流动力学研究发现，动脉狭窄局部可见明显血流动力学变化。症状组较非症状组狭窄局部壁面剪切力偏高[78．69（68．15，117．65）Pa与39．34（22．76，60．54）Pa，U=4，P=0．003]、管壁压力偏大[1815．14（1242．44，4398．84）Pa与735．55（361．17，l528．78）Pa，U=7，P=0．010]、血流速度偏快[3．87（2．58，4．52）m／s与2．31（1．38，3．12）m／s，U=12，P=0．046]，而震荡剪切指数在两组间比较差异没有明显统计学意义。结论颅内动脉粥样硬化狭窄伴有明显血流动力学改变，其中壁面剪切力、管壁压力及流速是发生症状性颅内动脉狭窄的危险因素。Objective To study the role of risk factors associated with hemodynamies in patients with intraeranial artery stenosis. Methods Eighteen patients with local stenosis of middle cerebral artery were recruited in this study retrospectively. According to patients＇ elinieal symptoms and magnetic resonance imaging findings, they were divided into the symptomatic group （ n= 13 ） and the asymptomatie group （ n = 5 ）. Wall shear stress （WSS） , oscillatory shear index （OSI） , velocity and pressure of the stenotie artery wall were compared between the two groups after reconstructing 3-dimentional model of hemodynamies. Then related risk factors of hemodynamies were analyzed in symptomatic intracranial atherosclerotie stenosis. Results There were no statistically significant differences between the two groups in the parameters such as age, sex, degree of artery stenosis, mean arterial pressure and some medical histories of hypertension and diabetes. The results showed obvious changes of hemodynamies in local artery stenosis. The WSS（78. 69 （68, 15,117.65） Pays 39.34（22,76,60.54） Pa, U=4,P=0.003）, pressure of the stenotic artery wall （ 1 815.14 （ 1 242. 44,4 398.84） Pavs 735.55 （ 361.17,1 528.78 ） Pa, U = 7, P = 0.010） and velocity of the local stenosis （3.87 （2. 58, 4. 52） m/s vs 2.31 （1.38,3.12） m/s, U = 12, P = 0. 046）in the symptomatic group were much higher than those in the asymptomatie group; however, there were no significant differences between the two groups in OSI. Conclusions Hemodynamic features do exist in local intraeranial atherosclerotic stenosis. The WSS, wall pressure and velocity of the local stenosis may be vital risk factors associated with symptomatic intracranial atherosclerotie stenosis.

关 键 词：血流动力学 颅内动脉硬化 脑血管造影术 血流速度 回顾性研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]