椎动脉颅外段血流参数变化与颅内段狭窄病变程度的相关性分析  

Correlation between the hemodynamic parameters of extracranial vertebral artery and the severity and location of intracranial vertebral artery stenosis

作　　者：李秋萍[1] 华扬[1] 杨洁[1] 高明杰[1] 王力力[1] 雷娜[1] Li Qiuping;Hua Yang;Yang Jie;Gao Mingjie;Wang Lili;Lei Na(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：《中华超声影像学杂志》2019年第11期940-944,共5页Chinese Journal of Ultrasonography

摘　　要：目的通过椎动脉颅外段血流频谱与血流动力学参数的检查结果,分析颅内段椎动脉狭窄程度、部位对颅外段椎动脉血流动力学的影响。方法连续纳入2015年1月至2017年12月期间在首都医科大学宣武医院神经内科、神经外科诊断为后循环缺血性卒中或短暂性脑缺血发作(TIA)的住院患者,经头颈部CT血管成像(CTA)或数字减影血管成像(DSA)检查,明确为单侧椎动脉颅内段狭窄性病变的患者共计275例,常规头颈部血管超声检查记录椎动脉颅外段(V2段)收缩期峰值流速(PSV)、舒张期末流速(EDV)及血管阻力指数(RI值)。根据CTA或DSA界定的椎动脉颅内段病变将患者分为轻度狭窄组(53例)、中度狭窄组(62例)、重度狭窄组(58例)和闭塞组(102例),根据狭窄或闭塞部位与小脑后下动脉(PICA)的关系,再将重度狭窄组和闭塞组分别分为PICA分支前(分别为30例、37例)和PICA分支后(分别为28例、65例)2个亚组。比较四组及各两个亚组间椎动脉颅外段不同血流动力学参数的差异。结果随着椎动脉颅内段狭窄程度的加重,V2段PSV和EDV均呈减低趋势,RI呈升高趋势。重度狭窄组和闭塞组PSV和EDV均明显低于轻度狭窄组和中度狭窄组(P=0.000),且闭塞组PSV和EDV明显低于重度狭窄组[(31±10)cm/s对(46±12)cm/s,(5±4)cm/s对(15±7)cm/s;均P=0.000],RI明显高于其他三组(分别为0.85±0.12、0.70±0.10、0.66±0.07、0.64±0.06,P=0.000);重度狭窄组RI值与轻、中度狭窄组差异无统计学意义(P=0.044,0.223)。重度狭窄组无论狭窄部位位于PICA分支前或分支后,颅外段椎动脉的内径、PSV、EDV、RI差异均无统计学意义(P=0.130,0.322,0.865,0.227);闭塞组亚组间V2段内径及PSV差异也无统计学意义(P=0.318,0.079),但EDV、RI存在显著差异,颅内段椎动脉于PICA分支前闭塞者颅外段V2的RI明显升高,EDV明显降低(均P=0.000)。结论颅内段椎动脉病变部位及程度直接影响颅外段椎动脉的血�Objective To analyze the effects of the degree and location of intracranial vertebral artery(VA)lesions on the hemodynamic parameters of extracranial VA.Methods A total of 275 consecutive patients who were diagnosed as posterior circulation ischemic stroke or transient ischemic attack(TIA)with unilateral intracranial VA stenosis or occlusion in the Department of Neurology and Neurosurgery of Capital Medical University Xuanwu Hospital from January 2015 to December 2017 were enrolled.All patients were examined by head and neck vascular ultrasound,CT angiography(CTA)and/or digital subtraction angiography(DSA)within one week.According to the results of DSA or CTA,the patients were divided into mild stenosis group(53 patients),moderate stenosis group(62 patients),severe stenosis group(58 patients)and occlusion group(102 patients).The inner diameter(D),peak systolic velocity(PSV),end diastolic velocity(EDV),and resistance index(RI)of the extracranial segment(V2 segment)of the VA were recorded and analyzed.Results The PSV and EDV in the severe stenosis group and the occlusion group were significantly lower than those in the mild stenosis group and the moderate stenosis group(P=0.000),and the PSV and EDV in the occlusion group were significantly lower than those in the severe stenosis group[(31±10)cm/s vs(46±12)cm/s,(5±4)cm/s vs(15±7)cm/s;all P=0.000],RI was significantly higher than the other three groups(0.85±0.12,0.70±0.10,0.66±0.07,0.64±0.06,respectively;all P=0.000);RI in the severe stenosis group were not significantly different from those in the mild to moderate stenosis groups(P=0.044,0.223).There were no significant differences in the inner diameter,PSV,EDV and RI between the subgroups in the severe stenosis group before or after the PICA(posterior inferior cerebellar artery)(P=0.130,0.322,0.865,0.227).However,the EDV decreased and RI increased in the occlusive subgroup before the PICA when compared the subgroup after the PICA(all P=0.000).Conclusions The location and degree of intracranial VA lesions di

关 键 词：超声检查 椎动脉狭窄 闭塞性疾病 血流动力学 颅外段 颅内段 

分 类 号：R74[医药卫生—神经病学与精神病学]