颈部血管超声评估颅外段椎动脉狭窄及颅内段狭窄程度的价值  

EVALUATION OF EXTRACRANIAL VERTEBRAL ARTERY STENOSIS AND INTRACRANIAL STENOSIS BY CERVICAL VASCULAR ULTRASOUND

作　　者：刘洪[1] 李嘉舟 王大莲 蒋丽娜[1] 郑东[1] 徐向东[1] 孟青[1] LIU Hong;LI Jiazhou;WANG Dalian;JIANG Lina;ZHENG Dong;XU Xiangdong;MENG Qing(Dazhou integrated traditional Chinese and Western medicine hospital,Dazhou 635000,China)

机构地区：[1]四川省达州市中西医结合医院,635000

出　　处：《中国煤炭工业医学杂志》2022年第6期659-663,共5页Chinese Journal of Coal Industry Medicine

基　　金：四川省卫生和计划生育委员会科研重点研究项目(编号:20PJ312);达州市科技局科研项目(编号:19YYJC0014)。

摘　　要：目的 探讨颈部血管超声评估颅外段椎动脉狭窄及颅内段狭窄程度的价值。方法 选取2017年5月—2021年5月在达州市中西医结合医院就诊的疑似颅外段椎动脉狭窄患者75例,分析超声与数字减影血管造影术(Digital subtraction angiography.DSA)检查结果差异;同时选取2017年5月—2021年5月在达州市中西医结合医院就诊的颅内段狭窄患者57例,分析颅外段(V2段)椎动脉参数:收缩期峰值速度(Peak systolic flow velocity.PSV)、舒张末期血流速度(End-diastolic blood flow velocity.EDV)和血管阻力指数(Resistance index.RI)预测中重度颅内段狭窄的价值。结果 75例疑似颅外段椎动脉狭窄患者中,经DSA检查确诊狭窄患者48例,闭塞患者3例。超声诊断颅外段椎动脉狭窄的灵敏性、特异性、准确性、阳性预测值和阴性预测值分别为92.16%、79.17%、88.00%、90.38%和82.61%。超声判断颅外段椎动脉狭窄程度与DSA结果一致性Kappa值为0.793,P<0.05。中重度颅内段狭窄患者V2段血流PSV和EDV分别为(47.70±12.21)cm/s和(14.65±4.49)cm/s,明显低于轻度狭窄患者(P<0.05);中重度和轻度狭窄患者V2段血管内径、RI比较差异无统计学意义(P>0.05)。小脑后下动脉(Posterior inferior cerebellar artery.PICA)分支前和分支后中重度颅内段狭窄V2段血管内径、PSV、EDV和RI比较差异无统计学意义(P>0.05)。V2段血流参数PSV、EDV预测中重度颅内段狭窄的接受者操作特定(Receive Operating Characteristic)曲线下面积分别为0.822和0.735。结论 颈部血管超声评估颅外段椎动脉狭窄有较好的诊断价值,同时V2段椎动脉血流参数在预测中重度颅内段狭窄方面有较好的应用价值。Objective To evaluate the value of cervical vascular ultrasound in the evaluation of extracranial vertebral artery stenosis and the degree of intracranial stenosis.Methods Seventy-five patients with suspected extracranial vertebral artery stenosis treated in Dazhou Integrated Traditional Chinese and Western Medicine Hospital from May 2017 to may 2021 were selected, the difference between ultrasound and digital subtraction angiography(DSA) were analyzed.At the same time, fifty-seven patients with intracranial segment stenosis treated in Dazhou Integrated Traditional Chinese and Western Medicine Hospital from May 2017 to May 2021 were selected, the value of extracranial segment(V2 segment) vertebral artery parameters: peak systolic velocity(PSV),end diastolic blood flow velocity(EDV) and vascular resistance index(RI) in predicting moderate and severe intracranial segment stenosis were analyzed.Results Among 75 patients with suspected extracranial vertebral artery stenosis, 48 patients with stenosis and 3 patients with occlusion were diagnosed by DSA.The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasoundin the diagnosis of extracranial vertebral artery stenosis were 92.16%,79.17%,88.00%,90.38% and 82.61%,respectively.The degree of extracranial vertebral artery stenosis judged by ultrasound was consistent with the results of DSA,and the kappa value was 0.793,P<0.05.The PSV and EDV of V2 segment in patients with moderate and severe intracranial stenosis were(47.70 ± 12.21) cm/s and(14.65 ± 4.49) cm/s, respectively, which were significantly lower than those in patients with mild stenosis(P<0.05).There was no significant difference in diameter and RI of V2 segment between patients with moderate, severe and mild stenosis(P>0.05).There was no significant difference in vessel diameter, PSV,EDV and RI of V2 segment of moderate and severe intracranial stenosis before and after the branch of posterior inferior cerebellar artery(PICA)(P>0.05).The areas under the ROC curv

关 键 词：颈部血管超声 颅外段 颅内段 椎动脉 狭窄程度 

分 类 号：R61[医药卫生—外科学]