单侧中度颈动脉狭窄患者眼部血流动力学参数与缺血性脑卒中的相关性  

Correlation analysis of ocular hemodynamic parameters and ischemic stroke in patients with unilateral moderate carotid artery stenosis

作　　者：任远 王小敏[1] 王保君[1] 李新民[1] 李庆博 宋杰 REN Yuan;WANG Xiaomin;WANG Baojun;LI Xinmin;LI Qingbo;SONG Jie(Dapartment of Ophthalmology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;Xinxiang Medical University,Xinxiang 453000,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院眼科,河南省卫辉市453100 [2]新乡医学院,河南新乡市453000

出　　处：《眼科新进展》2021年第5期442-446,共5页Recent Advances in Ophthalmology

基　　金：河南省医学科技攻关项目(编号:SBGJ2018055)。

摘　　要：目的探讨单侧中度颈动脉狭窄患者眼部血流动力学参数与缺血性脑卒中的相关性,并分析各血流动力学参数的临床意义。方法纳入88例176眼单侧中度颈动脉狭窄型缺血性脑卒中患者(A组)及51名51眼健康对照者(B组),采用彩色超声多普勒测量眼动脉(OA)、视网膜中央动脉(CRA)的收缩期最高血流速度(PSV)、舒张期末期最低血流速度(EDV)、阻力指数(RI)、搏动指数(PI)、PSV与EDV比值(S/D)。A组中同一患者根据颈动脉超声检查结果又分为颈动脉狭窄侧(A 1组)、非颈动脉狭窄侧(A 0组),分别比较A 1组、A 0组和B组受试者眼部血流动力学参数差异。评价各参数诊断阈值及效能,同时分析各参数与中度颈动脉狭窄型缺血性脑卒中的相关性。结果A 1组受试者OA中PSV(t=3.16,P=0.020)、EDV(t=3.39,P=0.011)均低于B组,A 1组受试者OA中PI(t=3.33,P=0.010)、RI(t=9.92,P<0.01)、S/D(t=3.95,P<0.01)均高于B组;A 1组受试者CRA中PSV(t=16.60,P<0.01)、EDV(t=11.58,P<0.01)、S/D(t=2.77,P=0.016)均明显低于B组;A 0组受试者OA中PSV(t=6.26,P<0.01)、EDV(t=3.66,P<0.01),CRA中PSV(t=4.37,P<0.01)、EDV(t=3.55,P=0.001)均高于A 1组。A 0组受试者OA中PI、RI、S/D均高于B组,差异均有统计学意义(均为P<0.01),CRA中S/D低于B组,差异有统计学意义(P=0.013)。Logistic回归分析发现,OA中EDV(OR=4.219,95%CI为1.410~12.092,P=0.010)、RI(OR=7.756,95%CI为3.876~15.522,P=0.001)、S/D(OR=3.969,95%CI为3.208~3.597,P=0.003)中OR值均大于1。其中RI对中度颈动脉狭窄型缺血性脑卒中具有较高诊断效能(曲线下面积为0.899,最佳诊断临界值为0.655,敏感度为88.6%,特异度为66.7%)。结论单侧中度颈动脉狭窄型缺血性脑卒中患者患侧眼血流呈低速高阻力型改变,OA中EDV、RI、S/D为缺血性脑卒中发生的影响因素,OA的增高可能与脑卒中发生风险增高有关。Objective To investigate the correlation between ocular hemodynamic parameters and ischemic stroke in patients with unilateral moderate carotid artery stenosis,and to analyze the clinical significance of blood flow parameters.Methods Totally 176 eyes of 88 patients with ischemic stroke with unilateral moderate carotid artery stenosis(group A)and 51 eyes of 51 healthy controls(group B)were included.Peak systolic velocity(PSV),end diastolic velocity(EDV),resistance index(RI),pulsatility index(PI)and the ratio of PSV to EDV(S/D)of ophthalmic artery(OA),central retinal artery(CRA)were measured by color Doppler ultrasound.According to the results of carotid ultrasonography,the eyes of the same patients in group A were divided into stenosed side of carotid artery(group A 1)and non-stenosed side of carotid artery(group A 0).The differences of ocular hemodynamic parameters among group A 1,group A 0 and group B were compared respectively.The diagnostic threshold and efficacy of each parameter were evaluated,and the correlation between each parameter and ischemic stroke with moderate carotid artery stenosis was analyzed.Results The PSV(t=3.16,P=0.020)and EDV(t=3.39,P=0.011)of OA of the subjects in group A 1 were lower than those in group B,while the PI(t=3.33,P=0.010),RI(t=9.92,P<0.01)and S/D(t=3.95,P<0.01)in group A 1 were higher than those in group B.The CRA of subjects in group A 1 was significantly lower than that of group B in PSV(t=16.60,P<0.01),EDV(t=11.58,P<0.01),and S/D(t=2.77,P=0.016).The OA of subjects in group A 0 was higher than that of group A 1 in PSV(t=6.26,P<0.01)and EDV(t=3.66,P<0.01),and CRA was higher than that of group A 1 in PSV(t=4.37,P<0.01)and EDV(t=3.55,P=0.001).Logistic regression analysis showed that EDV(OR=4.219,95%CI:1.410-12.092,P=0.010),RI(OR=7.756,95%CI:3.876-15.522,P=0.001)and S/D(OR=3.969,95%CI:3.208-3.597,P=0.003)were found in OA,among which RI had higher diagnostic efficiency for ischemic stroke with moderate carotid stenosis(the area under the curve was 0.899,the best diagnostic thresh

关 键 词：颈动脉狭窄 缺血性脑卒中 眼动脉 视网膜中央动脉 眼部血流动力学 

分 类 号：R770.4[医药卫生—眼科]