颈部血管超声评估椎动脉颅内段狭窄的可行性分析  

Evaluation of intracranial stenosis of vertebral artery with carotid Doppler ultrasonography:a feasibility analysis

作　　者：丁亚芳[1] 惠品晶[1] 仲伟花 杨甲[1] 郭亮[2] 胡春洪[2] 

机构地区：[1]苏州大学附属第一医院颈脑血管超声科,215006 [2]苏州大学附属第一医院影像科,215006

出　　处：《中国脑血管病杂志》2016年第12期638-643,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：苏州市临床重点病种诊疗技术专项项目(LCZX201403);江苏省第十批"六大人才高峰"高层次人才选拔培养项目(WSW-045);苏州市科技发展计划资助项目(SYS201326)

摘　　要：目的探讨颈部血管超声的血流动力学参数评估椎动脉颅内段狭窄的可行性。方法回顾性连续纳入2014年1月至2015年1月苏州大学附属第一医院神经内科以头痛、头晕为主诉的患者150例,根据单侧椎动脉颅内段是否有狭窄分为研究组[100例;一侧椎动脉管径(VAD)≤2.5 mm或与对侧VAD比值<1/1.7,且椎动脉颅内段狭窄]和单纯椎动脉发育不全(VAH)组(50例;一侧VAD≤2.5 mm或与对侧VAD比值<1/1.7,椎动脉全程未见狭窄),并纳入同期健康体检人群100例作为对照组(双侧VAD>2.5 mm,椎动脉全程无狭窄)。所有研究对象行颈部血管超声、CT血管成像(CTA)和(或)DSA检查。采用颈部血管超声记录VAD、收缩期峰值流速(PSV)、舒张期末流速(EDV)、阻力指数、时均平均峰值流速,并计算椎动脉血流量及阻力指数差值。比较3组血流动力学参数的差异,并对研究组患侧、单纯VAH组VAH侧、对照组左侧进行两两比较;评价不同参数对椎动脉颅内段狭窄诊断的可行性。结果椎动脉椎间段阻力指数诊断准确性较高,阻力指数差值、血流量、EDV、VAD有一定准确性,PSV的诊断准确性较差;其中,阻力指数为0.754、阻力指数差值为0.151、血流量为56.52 ml/min、EVD为9.5 cm/s、VAD为2.095 mm是诊断椎动脉颅内段狭窄最佳界值(最大Youden指数分别为0.695、0.605、0.383、0.495、0.381,敏感度分别为83.8%、63.6%、89.8%、81.6%、87.6%,特异度分别为85.7%、96.9%、48.5%、67.9%、50.5%,准确度分别为87.3%、80.2%、79.5%、67.7%、65.2%)。结论颈部血管超声检测椎动脉椎间段阻力指数、阻力指数差值、血流量、EDV、VAD可作为评估椎动脉颅内段狭窄的参考,为及早诊断后循环缺血提供依据。Objectives To investigate the feasibility of the hemodynamic parameters for evaluating the intracranial stenosis of vertebral artery with carotid Doppler ultrasonography. Methods From January2014 to January 2015,a total of 150 consecutive patients complained of headache and dizziness at the Department of Neurology,the First Affiliated Hospital of Soochow University were retrospectively enrolled.According to whether having unilateral vertebral artery stenosis or not,they were divided into a study group（ n = 100; unilateral vertebral artery diameter[VAD]≤2. 5 mm or compared with the contralateral side VAD ratio 1 /1. 7,intracranial stenosis of vertebral artery） and a simple vertebral artery hypoplasia（ VAH） group（ n = 50; unilateral VAD≤2. 5 mm or compared with VAD ratio of the contralateral side 1 /1. 7,the whole vertebral artery without obvious stenosis）. All subjects underwent carotid Doppler ultrasonography,CT angiography and / or DSA examinations. The vertebral artery diameter（ VAD）,peak systolic velocity（ PSV）,end diastolic velocity（ EDV）,resistance index（ RI）,and the mean flow peak velocity were recorded by the neck vascular ultrasound,and the differences of blood flow of vertebral artery and resistance index were calculated. The differences of hemodynamic parameters among the 3 groups were compared,and the affected sides of the study group,the VHA side of the simple VAH group,and the left side of the control group were compared with the pairwise comparison. The feasibility of different parameters for the diagnosis of intracranial stenosis of vertebral artery was evaluated. Results The diagnostic accuracy of the resistance index of the intervertebral segment of vertebral artery was higher,the resistance index difference,BF,EDV,and VAD had certain accuracy,while the accuracy of PSV was poorer,in which the resistance index of the intervertebral segment of vertebral artery = 0. 754,the resistance index difference =0. 151,blood flow = 56. 52 ml / min,EDV = 9. 5 cm / s and VAD = 2.

关 键 词：颈部血管超声 椎动脉 颅内段 狭窄 阻力指数 血流量 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]