急性期和慢性期颈内动脉闭塞患者侧支循环类型对颅内血流灌注的影响  

Effects of collateral circulation types on intracranial blood perfusion in patients with acute and chronic internal carotid artery occlusion

作　　者：刘欢颜 华扬[1] 贾凌云[1] 赵新宇[1] 刘蓓蓓[1] Liu Huanyan;Hua Yang;Jia Lingyun;Zhao Xinyu;Liu Beibei(Department of Vascular Ultrasonography,Xuanwu Hospital,Capital Medical University,Beijing Diagnostic Center of Vascular Ultrasound,Center of Vascular Ultrasonography,Beijing Institute of Brain Disorders,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院血管超声科北京市血管超声诊断中心北京脑重大疾病研究院血管超声研究所,100053

出　　处：《中国脑血管病杂志》2022年第6期396-404,共9页Chinese Journal of Cerebrovascular Diseases

基　　金：首都卫生发展科研专项(2018-2-2011)。

摘　　要：目的 探索急性期和慢性期颈内动脉闭塞(ICAO)患者侧支循环对颅内血流灌注的影响。方法 回顾性连续纳入2017年9月至2021年10月因脑梗死于首都医科大学宣武医院神经内科或神经外科住院的ICAO患者386例,根据患者出现临床症状到入院治疗的时间间隔,将其分为急性期组(≤4周)和慢性期组(>4周)。联合应用颈动脉彩色多普勒超声与经颅彩色多普勒超声对两组患者颅内血流动力学和侧支循环类型进行检测,同时应用血管造影检查侧支循环的开放情况,并对超声检查与血管造影的结果进行一致性检验。收集两组患者性别、年龄、身高、体质量、脑血管病危险因素(高血压病、糖尿病、高脂血症、吸烟、心房颤动、脑梗死、冠心病)及血管超声参数[管腔内径、收缩期峰值流速(PSV)、舒张期末流速(EDV)、侧支循环开放情况(侧支循环数量、开放类型)],并进行组间比较;对不同侧支(前交通动脉、后交通动脉、颈内-颈外动脉侧支)开放与否的血管超声参数进行比较。计算超声检查对不同侧支循环开放类型的敏感度、特异度、准确度。结果 (1)386例ICAO患者中,急性期组165例,慢性期组221例。急性期组ICAO男性比例低于慢性期组,冠心病比例高于慢性期组,组间差异均有统计学意义(均P<0.05)。年龄、高血压病、糖尿病、高脂血症、吸烟、心房颤动、脑梗死、体质量指数的差异均无统计学意义(均P>0.05)。(2)超声检查显示,慢性期组后交通动脉开放率高于急性期组[52.5%(116/221)比40.0%(66/165),χ^(2)=5.913,P=0.015]。急性期组侧支循环开放数量主要为1~2支,占比分别为33.3%(55/165)、52.1%(86/165);而慢性期组侧支循环开放数量主要为1~3支,占比分别为24.0%(53/221)、53.4%(118/221)、19.0%(42/221),侧支循环数量分布的组间差异有统计学意义(χ^(2)=11.394,P=0.010)。(3)超声检查显示前交通动脉、后交通动脉、颈内-颈�Objective To explore the effects of collateral circulation on intracranial blood perfusion in acute and chronic internal carotid artery occlusion(ICAO) patients.Methods A total of 386 ICAO patients hospitalized in the Department of Neurology or Neurosurgery of Xuanwu Hospital,Capital Medical University for cerebral infarction from September 2017 to October 2021 were retrospectively and consecutively enrolled.The patients were divided into acute stage group(≤4 weeks) and chronic stage group(>4 weeks).Carotid color Doppler ultrasound and transcranial color Doppler ultrasound were combined to detect intracranial hemodynamics and collateral circulation types of patients in the two groups.Meanwhile,the opening of collateral circulation was examined by angiography,and the consistency of ultrasound and angiography results was tested.Information including sex,age,height,body mass,and cerebrovascular disease risk factors(hypertension,diabetes,hyperlipidemia,smoking,atrial fibrillation,cerebral infarction,coronary heart disease) and vascular ultrasound parameters(lumen diameter,peak systolic velocity [PSV],end diastolic velocity [EDV],collateral circulation opening [amount and opening type]) were collected and compared between the two groups of patients.The ultrasonic parameters of different branches(anterior communicating artery [ACoA],posterior communicating artery [PCoA],internal-external carotid artery [E-I]) were compared.The sensitivity,specificity and accuracy of ultrasonic examination for different collateral circulation opening types were calculated.Results(1) Among 386 cases of ICAO,165 cases were in acute stage group and 221 cases were in chronic stage group.The proportion of male ICAO in acute stage group was lower than that in chronic stage group,and the proportion of coronary heart disease was higher than that in chronic stage group,with statistical significance(both P<0.05).There were no significant differences in age,hypertension,diabetes,hyperlipidemia,smoking,atrial fibrillation,cerebral infarction and

关 键 词：颈内动脉 动脉闭塞性疾病 前交通动脉 超声检查 

分 类 号：R743.3[医药卫生—神经病学与精神病学]