颈内动脉闭塞患者侧支循环类型与大脑中动脉血流速度及神经功能评分的相关性  

Correlation between types of collateral circulation and blood flow velocity of middle cerebral artery and neurological function scores in patients with internal carotid artery occlusion

作　　者：赵新宇[1] 华扬[1] 高明杰[1] 杨洁[1] 段春[1] 夏明钰[1] Zhao Xinyu;Hua Fang;Gao Mingjie;Fang Jie;Duan Chun;Xia Mingyu(Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管超声诊断科,北京100053

出　　处：《中国脑血管病杂志》2018年第8期414-419,F0003,共7页Chinese Journal of Cerebrovascular Diseases

基　　金：首都卫生发展科研专项项目(2018-2-2011)

摘　　要：目的分析颈内动脉闭塞(ICAO)缺血性卒中患者侧支循环开放类型对患侧大脑中动脉(MCA)的收缩期峰值流速(PSV)与临床神经功能的相关性。方法回顾性连续纳入2015年1月至2017年6月首都医科大学宣武医院经彩色多普勒血流显像、经颅多普勒超声(TCD)和(或)经颅彩色多普勒超声TCCS对颈部及颅内动脉诊断的ICAO住院患者363例,根据头部MRI或CT结果确诊患侧颈内动脉供血区新发脑梗死255例,无脑梗死108例。通过TCCS和(或)TCD检测记录患侧PSVMCA,并根据颅内侧支循环的开放类型为前交通动脉开放(Aco A组)、后交通动脉开放(Pco A组)、颈内-外动脉侧支开放(E-I组)及无交通支开放(None组)。对新发脑梗死患者以美国国立卫生研究院卒中量表(NIHSS)评分行神经功能评估,比较ICAO新发脑梗死患者不同侧支循环开放类型患侧PSVMCA及NIHSS的差异及其相关性。结果 (1)新发脑梗死组Aco A开放比例低于无脑梗死组[54.1%(138/255)比70.4%(76/108),P=0.004];PSVMCA低于无脑梗死组[(54±16)cm/s比(61±12)cm/s,P<0.01]。(2)不同侧支循环开放组间PSVMCA的差异有统计学意义(F=126.03,P<0.01),PSVMCA由高到低依次为ACo A组、PCo A组、E-I组、None组。(3)255例新发脑梗死患者,不同侧支循环类型PSVMCA(F=88.09,P<0.01)及NIHSS评分(Z=121.63,P<0.01)的差异有统计学意义。ACo A开放组PSVMCA最高、NIHSS评分最低,与其他3组两两比较的差异均有统计学意义(均P<0.01)。(4)PSVMCA与NIHSS评分呈显著负相关(r=-0.770,P<0.0 1)。结论 ICAO新发脑梗死患者ACo A侧支开放直接影响ICAO患者患侧PSVMCA及临床神经功能,PSVMCA越高则NIHSS评分越低,神经功能受损程度也越轻。Objective To analyze the correlation between peak systolic velocity（ PSV） of ipsilateral middle cerebral artery（ MCA） and clinical neurological function in the open types of collateral circulation in ischemic stroke patients with carotid artery occlusion（ ICAO）. Methods From January 2015 to June2017,363 consecutive inpatients with ICAO admitted to Xuanwu Hospital,Capital Medical University and diagnosed cervical and intracranial arteries with color Doppler flow imaging and TCD and/or TCCS were enrolled retrospectively. Two hundred and fifty-five patients with new cerebral infarction in the ipsilateral area of the internal carotid artery blood supply area and 108 without cerebral infarction were diagnosed according to the findings of head MRI or CT. TCCS and/or TCD were used to measure the ipsilateral PSVMCAand they were divided into anterior communicating artery open（ Aco A group）,posterior communicating artery open（ Pco A group）,internal-external carotid artery collateral branch open（ E-I group）,and no communicating branch open（ none group） according to the open types of intracranial collateral circulation. The neurological function in patients with new cerebral infarction was evaluated with the NIHSS scores. The differences and correlations between PSVMCAand NIHSS on the ipsilateral sides in different collateral circulation open types in ICAO patients with new cerebral infarction were compared. Results（ 1） The proportion of Aco A open in the new cerebral infarction group was lower than that in the non-cerebral infarction group（ 54. 1% [138/255]vs. 70. 4% [76/108],P = 0. 004）; and PSVMCAwas lower than that of the noncerebral infarction group（ 54 ± 16 cm/s vs. 61 ± 12 cm/s,P〈0. 01）.（ 2） There were significant differences in PSVMCAamong the different collateral circulation open groups（ F = 126. 03,P〈0. 01）. The order of PSVMCAfrom high to low was the ACo A group,PCo A group,E-I group,and none group.（ 3） There were statistically significant in PSVMCA（ F =

关 键 词：颈内动脉闭塞 侧支循环 超声检查 多普勒 经颅 超声检查 多普勒 彩色 大脑中动脉 血流速度 

分 类 号：R743.3[医药卫生—神经病学与精神病学]