经颅多普勒超声联合直立倾斜试验对直立性脑低灌注综合征的诊断价值  

Diagnostic value of transcranial Doppler combined with head-up tilt test in orthostatic cerebral hypoperfu-sion syndrome patients

作　　者：王佳玉[1] 吴越阳 张佳 刘杰昕 WANG Jiayu;WU Yueyang;ZHANG Jia;LIU Jiexin(Neurosurgery and Cardiology Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京天坛医院神经心脏中心,北京100050 [2]首都医科大学附属北京天坛医院神经病学中心,北京100050

出　　处：《实用心电学杂志》2022年第5期330-335,共6页Journal of Practical Electrocardiology

基　　金：空间站工程航天医学实验领域资助项目(HYZHXM01011)。

摘　　要：目的探讨经颅多普勒超声(transcranial Doppler,TCD)联合直立倾斜试验(head-up tilt test,HUTT)对直立性脑低灌注综合征(orthostatic cerebral hypoperfusion syndrome,OCHOs)的诊断价值。方法选取因晕厥或疑似直立不耐受就诊、病因考虑为OCHOs的患者。收集患者TCD脑血流指标及HUTT血流动力学指标,并设立健康对照组。比较OCHOs患者与对照组的TCD脑血流指标及HUTT血流动力学指标。结果共纳入OCHOs患者56例(病例组),对照组21例。在TCD脑血流指标方面,同平卧位相比,病例组患者在倾斜直立位的收缩期、舒张期末和平均脑血流速度下降绝对值均显著高于对照组,搏动指数和循环阻力指数增加绝对值也显著高于对照组(P均<0.01)。在HUTT血流动力学指标方面,两组之间差异无统计学意义(P>0.05)。绘制受试者工作特征曲线,同平卧位相比,病例组患者在倾斜直立位的收缩期、舒张期末及平均脑血流速度分别下降14.5、9.5和13.5 cm/s,其诊断OCHOs的敏感性分别为94.6%、87.5%和91.1%,特异性分别为95.2%、85.7%和95.2%(P<0.01)。结论TCD联合HUTT对OCHOs患者的诊断有重要价值。Objective To investigate the diagnostic value of transcranial Doppler(TCD)combined with headup tilt test(HUTT)in patients with orthostatic cerebral hypoperfusion syndrome(OCHOs).Methods We selected the patients going to hospital due to syncope or suspected orthostatic intolerance,and their etiology was considered as OCHOs.Cerebral blood flow parameters and hemodynamic parameters of patients were collected separately by TCD and HUTT,and healthy control group was set up.TCD cerebral blood flow parameters and HUTT hemodynamic parameters were compared between the OCHOs patients and the control group.Results A total of 56 OCHOs patients(case group)and 21 healthy adults in the control group are enrolled.In terms of TCD cerebral blood flow parameters,compared with the supine position,the absolute values of the decrease of systolic,enddiastolic and mean cerebral blood flow velocity in the case group are significantly higher than those in the control group during the tilt upright position;the absolute values of the increase of pulse index and circulation resistance index are also significantly higher than those in the control group(P<0.01).There is no significant difference in HUTT hemodynamic parameters between the two groups(P>0.05).The receiver operator characteristic curve is drawn.Compared with the supine position,systolic,end-diastolic and mean cerebral blood flow velocity in the case group decrease by 14.5,9.5 and 13.5 cm/s,respectively during the tilt upright position.Their sensitivity is sepa-rately 94.6%,87.5%and 91.1%while the specificity is separately 95.2%,85.7%and 95.2%in diagnosing OCHOs(P<0.01).Conclusion TCD combined with HUTT plays an important role in diagnosing OCHOs.

关 键 词：直立不耐受 直立性脑低灌注综合征 经颅多普勒超声 直立倾斜试验 

分 类 号：R445.1[医药卫生—影像医学与核医学] R743[医药卫生—诊断学]