椎动脉不同部位重度狭窄或闭塞的血流动力学参数与后循环缺血的相关性  

Relationship of Hemodynamic Parameters of Severe Stenosis or Occlusion in Different Segmental Vertebral Artery with Posterior Circulation Ischemia

作　　者：苗锐[1] 黄冬 赵凯涛 张晓梅 李阳 成毅 MIAO Rui;HUANG Dong;ZHAO Kai-tao(Department of Neurology,the Second People's Hospital of Shaanxi Province,Xi'an Shaanxi 710005)

机构地区：[1]陕西省第二人民医院神经内科,陕西西安710005

出　　处：《医学临床研究》2022年第12期1764-1767,共4页Journal of Clinical Research

基　　金：陕西省重点研发计划项目(2021SF-273)。

摘　　要：【目的】探讨椎动脉(VA)不同部位重度狭窄或闭塞的血流动力学参数与后循环缺血(PCI)的相关性。【方法】本院确诊为单侧VA的V1~V4段单纯的不同部位的重度狭窄或闭塞患者150例,依据VA重度狭窄或闭塞部位分为V1段(84例)、V2段(9例)、V3~V4段(57例)。通过颈动脉超声检查并记录VA各部位血流动力学参数,通过受试者工作特征(ROC)曲线分析V1~V4段血流动力学参数预测VA重度狭窄或闭塞的价值,并通过Logistic逐步回归分析检验血流动力学参数与PCI的相关性。【结果】V1段、V2段重度狭窄或闭塞时,患侧收缩期峰值血流速(PSV)、舒张期末血流速(EDV)及血管阻力指数(RI)均较健侧显著降低,VA椎间段管径(VAD)较健侧细;V3~V4段重度狭窄或闭塞时,患侧PSV、EDV均较健侧显著降低,VAD较健侧细(P<0.05);V3~V4段重度狭窄或闭塞时,患侧及健侧RI比较,差异无统计学意义(P>0.05)。经ROC分析发现,V1、V2段的PSV、EDV、RI、VAD及V3~V4段的PSV、EDV、VAD水平可用于VA重度狭窄或闭塞的预测(P<0.05);多因素分析显示,PCI与V1段、V2段重度狭窄或闭塞无明显相关性,V3~V4段PSV、EDV、VAD与PCI显著相关,是PCI发生的独立危险因素,V3~V4段RI与PCI无明显相关性。【结论】PCI与V3~V4段狭窄或闭塞有关,其中PSV、EDV越低和VAD越细均是可增加PCI发生风险。【Objective】To explore the relationship of hemodynamic parameters of severe stenosis or occlusion of vertebral artery(VA)with posterior circulation ischemia(PCI).【Methods】From September 2019 to March 2021,150 patients with severe stenosis or occlusion of V1~V4 segment of unilateral VA diagnosed by carotid ultrasound,angiography and angiography were retrospectively analyzed.According to the location of severe stenosis or occlusion VA,they were divided into the V1 segment(84 cases),V2 segment(9 cases)and V3~V4 segment(57 cases).Carotid artery ultrasound was used to check and record the hemodynamic parameters of each part of VA.ROC was used to analyze the hemodynamic parameters of V1~V4 segments to predict the value of severe stenosis or occlusion of VA.Logistic stepwise regression analysis was used to test the correlation between hemodynamic parameters and PCI.【Results】In severe stenosis or occlusion of V1 and V2 segments,peak systolic blood velocity(PSV),end diastolic blood velocity(EDV)and vascular resistance index(RI)of the affected side were significantly lower than those of the healthy side,and the diameter of VA intervertebral segment(VAD)was thinner than that of the healthy side.When V3~V4 segment was severely narrowed or occluded,the PSV and EDV of the affected side were significantly lower than those of the healthy side,and the VAD was thinner than that of the healthy side(P<0.05).When V3~V4 segment was severely narrowed or occluded,there was no difference in RI between the affected side and the healthy side(P>0.05).Through ROC analysis,it was found that the levels of PSV,EDV,RI,VAD in V1~V2 and PSV,EDV and VAD levels in V3~V4 can be used to predict the severe stenosis or occlusion of VA.Multivariate analysis showed that there was no significant correlation between PCI and severe stenosis or occlusion in V1 and V2 segments,while PSV,EDV and VAD in V3~V4 segments were significantly correlated with PCI,which were independent risk factors for PCI,while RI in V3~V4 segments had no significant correl

关 键 词：椎底动脉供血不足 血流动力学 脑梗死 

分 类 号：R743.33[医药卫生—神经病学与精神病学]