颈内动脉狭窄患者的CO_2反应性、脑电图及血清CRP研究  

STUDY OF CO_2 ACTIVITY,EEG AND CRP IN PATIENTS WITH INTERNAL CAROTID ARTERY STENOSIS

作　　者：袁端华[1] 林小慧[1] 蒋丽丽[1] 黄紫薇[1] 苏庆华[1] Duanhua Yuan Xiaohui Lin Lili Jiang Ziwei Huang Qinghua Su(Department of Neurology, First Affiliated Hospital of Guilin Medicine Institute, Guilin, 541001, China)

机构地区：[1]桂林医学院附属医院神经内科,541001

出　　处：《现代电生理学杂志》2017年第1期7-11,14,共6页Journal of Modern Electrophysiology

基　　金：广西壮族自治区卫生厅计划课题(Z2016382)

摘　　要：目的:检测颈内动脉狭窄患者的脑血管反应性(cerebrovascular reactivity,CVR),探讨颈内动脉狭窄程度与脑血管反应性之间的关系以及脑电图变化,同时探讨血浆C-反应蛋白(C-reactive protein,CRP)水平与脑动脉粥样硬化性狭窄的关系。方法:选择颈内动脉狭窄患者51例作为狭窄组,根据血管狭窄程度分为轻度狭窄组(n=18)、中度狭窄组(n=18)和重度狭窄组(n=15),同时期在我院健康体检者20例为对照组,采用德国DWL型TCD检测仪,结合二氧化碳试验分别测得过度换气、吸入CO_2气体、屏气后的大脑中动脉(middle cerebral artery,MCA)的脑血流速度,计算脑血管反应性。并对患者进行脑电图检查以及测定其血清hs-CRP浓度。结果:(1)颈内动脉狭窄组中患者通过过度换气、吸入CO_2气体、屏气后大脑中动脉的最大速度变化率、平均速度变化率均显著低于对照组,差异具有统计学意义(P<0.05)。(2)轻、中、重度颈内动脉-大脑中动脉狭窄患者吸入CO_2气体后各组MCA血流速度增加率依次减低,两两比较差异有统计学意义(P<0.05)。(3)51例患者中脑电图检查正常者15例(29.4%),异常者36例(70.6%),其中轻度异常16例(31.4%),中度异常包括局限性异常11例(21.6%),弥散异常一侧优势9例(17.6%)。(4)狭窄组的CRP浓度为(3.42±1.09)mg/L,对照组为(1.86±1.52)mg/L,差异有统计学意义(P<0.05)。结论:经颅多普勒超声检测可以作为评估脑血管反应性的简便手段之一。颈内动脉狭窄患者脑血管反应性差,狭窄越严重反应性越差。脑电图、CRP在急性脑血管疾病的早期诊断、病情评估及预后方面具有重要价值。Objective： To assess cerebrovascular reactivity （CVR） in patients with internal carotid artery （ICA） stenosis, explore the relationship between the degree of ICA stenosis and CVR, the change in EEG, and the relationship between plasma C-reactive protein （CRP） and ICA stenosis. Methods： Fifty-one patients with internal carotid artery stenosis were as narrow group, and according to the degree of stenosis, they were divided into mild stenosis group （n=18）, moderate stenosis group （n=18）, severe stenosis group （n=15） , and 20 healthy people were as control group. Combining transcranial doppler sonography （TCD） and CO2 test, we continuously detected the change of blood flow of middle cerebral artery （MCA） after hyperventilation, inhalation CO2 and breathlessness and evaluated CVR. EEG examination and serum hs-CRP determination was performed in 51 patients. Results： （1） The rate of maximum speed and average speed change were lower in ICA stenosis group than that of the control group after hyperventilation, inhalation CO2 and breathlessness, with statistically significant difference （P〈0.05）. （2） MCA blood flow increase rate reduced in turn in mild, moderate and severe stenosis group after inhalation CO2. There was statistically significant difference （P〈0.05）. （3） The results of EEG showed normal in 15 case （29.4%）, abnormal in 36 cases（70.6%）, in which mild abnormality was 16 cases （31.4%）, moderate abnormality including limitation abnormality was 11 cases （21.6%）, and 9 cases （17.6%） with dispersivity abnormality. （4） The concentration of CRP was （3.42 ±1.09） mg/L in narrow group, and （1.86±1.52） mg/L in control group, with significant difference （P〈0.05）. Conclusion： Transcranial doppier ultrasonic testing can be used as one of the simple means of evaluation of CVR. CVR is poor in patients with ICA stenosis, and the narrow is more severe, the reactivity is more poorer. EEG, CRP presents significant value in the ea

关 键 词：颈内动脉-大脑中动脉狭窄 脑血管反应性 经颅多普勒超声 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]