TCCD技术诊断急性缺血性脑卒中颈动脉狭窄与DSA一致性及其参数评估病情价值分析  

TCCD technology in the diagnosis of acute ischemic stroke with carotid artery stenosis and DSA consistency and analysis of the value of parameters in evaluating the condition

作　　者：肖敏[1] 程景华[1] 苟加梅[1] XIAO Min;CHENG Jinghua;GOU Jiamei(The Sixth People′s Hospital of Chengdu,Chengdu Sichuan 610051,China)

机构地区：[1]成都市第六人民医院,四川成都610051

出　　处：《中国急救复苏与灾害医学杂志》2023年第1期46-50,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：成都市医学科研课题(编号:2018112)。

摘　　要：目的 探究经颅彩色多普勒超声(TCCD)技术诊断急性缺血性脑卒中(AIS)颈动脉狭窄与数字减影血管造影(DSA)一致性及其参数评估病情价值。方法 选取成都市第六人民医院2019年10月—2021年8月80例AIS患者,均行TCCD检查,以DSA为金标准,分析其诊断颈动脉狭窄与DSA一致性,并评价其参数[舒张末期血流速度(EDV)、收缩期峰值流速(PSV)、平均血流速度(MV)、搏动指数(PI)]对病情的评估价值。结果 经DSA检查证实,颈动脉轻度狭窄19例,中度狭窄28例,重度狭窄30例,闭塞3例;TCCD检查显示,颈动脉轻度狭窄20例,中度狭窄30例,重度狭窄27例,闭塞3例。一致性分析,TCCD诊断AIS患者颈动脉狭窄与DSA一致性较高(Kappa值=0.872,95%CI:0.726~1.017,P<0.001);重度损伤患者EDV、PSV、MV低于中度、轻度损伤患者,中度损伤患者低于轻度损伤患者;重度损伤患者PI高于中度、轻度损伤患者,中度损伤患者高于轻度损伤患者(P<0.05)。Perason相关性分析显示,EDV、PSV、MV与病情程度呈负相关,PI与病情程度呈正相关(P<0.05);ROC曲线分析,EDV、PSV、MV、PI联合鉴别AIS轻度与中度损伤的曲线下面积(AUC)为0.889,95%CI为0.773~0.959,敏感度为87.10%,特异度为77.27%;联合评估重度损伤的AUC为0.886,95%CI为0.795~0.946,敏感度为77.78%,特异度为94.34%,均优于各指标单独鉴别、评估价值。结论 TCCD技术对AIS患者颈动脉狭窄有较好诊断价值,与DSA一致性较高,其参数EDV、PSV、MV、PI联合测定可作为临床评估病情的重要途径。Objective To explore the consistency of the diagnosis of acute ischemic stroke(AIS) carotid artery stenosis and digital subtraction angiography(DSA) with transcranial color Doppler ultrasound(TCCD) and the value of parameters in evaluating the condition.Methods A total of 80 AIS patients in our hospital from January 2019 to December 2020 were selected for TCD examination.DSA was used as the gold standard to analyze the consistency of the diagnosis of carotid artery stenosis and DSA,and parameters [end-diastolic blood flow velocity(EDV),peak systolic velocity(PSV),mean blood flow velocity(MV),pulsatility index(PI)] were used to assess the value of the disease.Results The DSA examination showed that there were 19 cases of mild carotid stenosis,28 cases of moderate stenosis,30 cases of severe stenosis,and 3 cases of occlusion;TCCD examination showed that there were 20 cases of mild carotid stenosis,30 cases of moderate stenosis,and 27 cases of severe stenosis,3 cases were occluded.Consistency analysis,TCD diagnosis of carotid artery stenosis in AIS patients was consistent with DSA(Kappa value=0.872,95%CI:0.726~1.017,P<0.001);EDV,PSV,MV in severely injured patients were lower than those in moderately and mild injured patients,patients with moderate injury were lower than those with mild injury,PI in severely injured patients was higher than patients with that with moderate and mild injury,and patients with moderate injury was higher than that with mild injury(P<0.05).Perason correlation analysis showed that EDV,PSV,MV were negatively correlated with the degree of illness,and PI was positively correlated with the degree of illness(P<0.05);ROC curve analysis showed that the AUC of EDV,PSV,MV,PI combined to identify mild and moderate AIS injuries was 0.889,95%CI was 0.773~0.959,sensitivity was 87.10%,specificity was 77.27%,and The AUC of joint assessment to identify severe injuries was0.886,95%CI was 0.795~0.946,the sensitivity was 77.78%,and the specificity was 94.34%,which was better than the individual identification

关 键 词：急性缺血性脑卒中 经颅彩色多普勒超声技术 颈动脉狭窄 数字减影血管造影 病情程度 

分 类 号：R651.1[医药卫生—外科学]