TCD结合TCCD与DSA对脑动脉狭窄的一致性分析及对治疗方案的指导价值  

Consistency analysis of TCD combined with TCCD and DSA for cerebral artery stenosis and its value in guiding treatment plan

作　　者：张姗 朱军[1] 方开峰[1] ZHANG Shan;ZHU Jun;FANG Kai-feng(Department of Ultrasound,General Hospital of Anhui Coal and Electricity Group,Suzhou 234000,China)

机构地区：[1]皖北煤电集团总医院超声科,安徽宿州234000

出　　处：《河北医科大学学报》2023年第1期100-105,共6页Journal of Hebei Medical University

基　　金：蚌埠医学院自然科学类项目(BYKY2019248ZD)。

摘　　要：目的探究经颅多普勒超声(transcranial Doppler sonography,TCD)结合经颅彩色多普勒超声(transcranial color-coded duplex,TCCD)与数字减影血管造影(digital subtraction angiography,DSA)对脑动脉狭窄的一致性分析及对治疗方案的指导价值。方法选取缺血性脑血管病患者100例,均行TCD、TCCD及DSA检查,以DSA检查结果作为“金标准”,分析脑动脉狭窄程度,观察不同狭窄程度患者TCD、TCCD超声表现,采用Kappa检验分析TCD结合TCCD诊断脑动脉狭窄程度与DSA检查结果的一致性,比较不同狭窄程度患者收缩期峰流速(systolic velocity,Vs)、平均峰流速(mean velocity,Vm)、搏动指数(pulsatility index,PI),采用Spearman相关系数模型分析Vm、PI与脑动脉狭窄程度的相关性,所有患者均行药物或手术治疗,比较不同治疗方法患者入院时、治疗后6个月Vs、Vm、PI。结果100例缺血性脑血管病患者,轻度狭窄42例,中度狭窄35例,重度狭窄20例,闭塞3例。TCD结合TCCD诊断缺血性脑血管病患者脑动脉狭窄程度与DSA诊断一致性的Kappa值为0.924(95%CI:0.790~1.059),诊断符合率为95.00%。重度狭窄患者Vs、Vm高于中度狭窄、轻度狭窄患者,PI低于中度狭窄、轻度狭窄患者,中度狭窄患者Vs、Vm高于轻度狭窄患者,PI低于轻度狭窄患者(P<0.05)。缺血性脑血管病患者Vs、Vm与脑动脉狭窄程度呈正相关,PI与脑动脉狭窄程度呈负相关(P<0.05)。手术治疗患者入院时Vs、Vm高于药物治疗患者,PI低于药物治疗患者,治疗后6个月Vs、Vm低于药物治疗患者,PI高于药物治疗患者,且手术治疗患者入院时与治疗后6个月Vs、Vm、PI差值均高于药物治疗患者(P<0.05)。结论TCD结合TCCD诊断缺血性脑血管病患者脑动脉狭窄程度与DSA的一致性很高,可为临床选择合适治疗方案提供可靠影像学参考。Objective To investigate the consistency of transcranial Doppler sonography(TCD)combined with transcranial color-coded duplex(TCCD)and digital subtraction angiography(DSA)for cerebral artery stenosis and its value in guiding treatment plan.Methods In total,100 patients with ischemic cerebrovascular disease were selected and underwent TCD,TCCD and DSA,and the DSA examination results were used as the“gold standard”to analyze the degree of cerebral artery stenosis,and to observe the ultrasound performance of TCD and TCCD in patients with different degrees of stenosis.The Kappa test was used to analyze the consistency of TCD combined with TCCD in the diagnosis of cerebral artery stenosis and the DSA examination results,and the systolic velocity(Vs),mean velocity(Vm)and pulsatility index(PI)of patients with different degrees of stenosis were compared.Spearman correlation coefficient model was used to analyze the correlation between Vm,PI and the degree of cerebral artery stenosis.All patients were treated medically or surgically,and Vs,Vm,and PI at admission and at 6 months after treatment were compared among patients that were given different treatment methods.Results In 100 patients with ischemic cerebrovascular disease,there were 42 cases of mild stenosis,35 cases of moderate stenosis,20 cases of severe stenosis,and 3 cases of occlusion.The Kappa value of the consistency between TCD combined with TCCD and DSA in the diagnosis of the degree of cerebral artery stenosis in patients with ischemic cerebrovascular disease was 0.924(95%CI:0.790-1.059),and the diagnostic agreement rate was 95.00%.Vs and Vm were higher in patients with severe stenosis than in patients with moderate stenosis and mild stenosis,while PI was lower than that in patients with moderate stenosis and mild stenosis;Vs and Vm were higher in patients with moderate stenosis than in patients with mild stenosis,and PI was lower than in patients with mild stenosis(P<0.05).Vs and Vm were positively correlated with the degree of cerebral artery stenosis

关 键 词：脑缺血 超声检查 多普勒 经颅 血管造影术 数字减影 

分 类 号：R743.31[医药卫生—神经病学与精神病学]