基于形态学和血流动力学的B型主动脉夹层病发机理分析  

Pathogenesis Analysis of Type-B Aortic Dissection Based on Morphological and Hemodynamic Parameters

作　　者：张薛欢 李振锋 许欢明 梅玉倩 赵天扬 鲍思达 熊江[3] 陈端端 ZHANG Xuehuan;LI Zhenfeng;XU Huanming;MEI Yuqian;ZHAO Tianyang;BAOSida;XIONG Jiang;CHEN Duanduan(School of Life Science,Beijing Institute of Technology,Beijing 100081,China;School of Arts and Sciences,the State University of New Jersey,NJ 08901-8554,USA;Department of Vascular and Endovascular Surgery,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]北京理工大学生命学院,北京100081 [2]School of Arts and Sciences,the State University of New Jersey,NJ 08901-8554,USA [3]解放军总医院血管外科,北京100853

出　　处：《医用生物力学》2020年第3期271-275,283,共6页Journal of Medical Biomechanics

基　　金：国家科技部重点研发计划(2017YFC0107900);国家自然科学基金项目(81770465)。

摘　　要：目的结合形态学分析与计算流体动力学(computational fluid dynamics,CFD)方法探索Stanford B型主动脉夹层病发机理,为有效预测B型主动脉夹层发生提供依据。方法对6例初发夹层患者(夹层组) CTA数据和6例正常志愿者(对照组) MRI黑血成像数据进行图像分割和三维重建,获得个体化的主动脉三维模型。使用压缩算法去除假腔,获得夹层病发前主动脉形态,与对照组进行对比。比较两组形态学参数和血流动力学参数之间的差异。结果与对照组相比,夹层组主动脉弓降交界处的截面积呈现明显增大[(892. 03±263. 78) mm^2 vs (523. 67±64. 10)mm^2,P=0. 036];左锁骨下动脉和主动脉之间的夹角明显减小(66. 62°±20. 11°vs 100. 40°±15. 35°,P=0. 036);主动脉弯曲度显著增加(0. 37°±0. 07°vs 0. 21°±0. 51°,P=0. 011);夹层组平均壁面剪切力(time-averaged wall shear stress,TAWSS)明显高于对照组;发生夹层区域的血液呈现低速漩涡流动状态;且夹层区域的震荡剪切指数(oscillating shear index,OSI)也明显升高。结论研究结果可用于指导临床B型主动脉夹层病发初期诊疗决策。Objective To investigate the pathogenesis of type-B aortic dissection by using morphological analysis and computational fluid dynamics(CFD)method,so as to provide evidence for the effective prediction of type-B aortic dissection.Methods Six primary type-B dissection cases scanned by CT(dissection group)and six normal cases applied to black-blood MRI(control group)were included in this study and patient-specific threedimensional(3D)models of aorta were established through image segmentation and 3D reconstruction.The pretype-B dissection aortas were constructed by applying the scaling algorithm to shrink the dissection and then compared with subjects in control group.The differences between morphological parameters and hemodynamic parameters of the two groups were compared.Results Compared with the normal cases,the area of the descending aorta increased dramatically in dissection group[(892.03±263.78)mm^2 vs(523.67±64.10)mm^2,P=0.036].A significant decrease in angle of the left subclavian artery occurred(66.62°±20.11°vs 100.40°±15.35°,P=0.036).The tortuosity of the aorta also had an obvious increase(0.37°±0.07°vs 0.21°±0.51°,P=0.011).The time-averaged wall shear stress(TAWSS)in dissection group was obviously higher than that in control group;the flow in the dissection region was vortex flow at low speed and the oscillating shear index(OSI)was higher.Conclusions The results of this study can be used to provide guidance for the early diagnosis and treatment of type-B aortic dissection.

关 键 词：B型主动脉夹层 计算流体动力学 形态学 血流动力学 

分 类 号：R318.01[医药卫生—生物医学工程]