经颅多普勒超声与数字减影血管造影评价缺血性脑卒中侧支循环的价值及与预后的相关性分析  

The value of transcranial Doppler sonography and digital subtraction angiography in evaluating collateral circulation in ischemic stroke and its correlation with prognosis

作　　者：王芳[1] 杨峰[2] 毛樱[1] 吴承龙[2] Wang Fang;Yang Feng;Mao Ying;Wu Chenglong(Special Examination Room,Shaoxing People′s Hospital,Shaoxing 312000,China;Department of Neurology,Shaoxing People′s Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市人民医院特殊检查室,绍兴312000 [2]绍兴市人民医院神经内科,绍兴312000

出　　处：《中国医师进修杂志》2023年第4期349-352,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨经颅多普勒超声(TCD)与数字减影血管造影(DSA)评价缺血性脑卒中(IS)侧支循环的价值及与预后的相关性。方法回顾性选取2017年1月至2020年12月绍兴市人民医院收治的350例IS患者作为研究对象,按照DSA结果分为有侧支循环组和无侧支循环组,按照预后情况分为预后良好组和预后不良组。分析TCD对IS侧支循环的评价结果与DSA评价结果的一致性,并分析其与预后的相关性。结果DSA结果显示,350例患者中无侧支循环118例,有侧支循环232例,其中1级侧支循环130例,2级侧支循环102例;TCD结果显示,350例患者中无侧支循环117例,有侧支循环233例,其中1级侧支循环131例,2级侧支循环102例。一致性检验显示,TCD对侧支循环的评估结果与金标准DSA具有高度一致性(Kappa值>0.9,P<0.05)。重复测量方差分析结果显示,时点效应、组间效应、时点和组间的交互效应可显著影响改良Rankin量表(mRS)评分变化(P<0.05);且有侧支循环组入院时、出院时、出院后3个月mRS评分低于无侧支循环组[(1.89±0.82)分比(2.98±0.98)分、(1.13±0.53)分比(2.45±0.80)分、(0.50±0.45)分比(1.86±0.80)分],差异有统计学意义(P<0.05)。预后良好组侧支循环率高于预后不良组[78.95%(150/190)比47.50%(76/160)],差异有统计学意义(P<0.05)。结论TCD对IS侧支循环的评价价值较高,且侧支循环与预后关系密切。Objective To explore the value of transcranial Doppler sonography(TCD)and digital subtraction angiography(DSA)in evaluating collateral circulation in ischemic stroke(IS)and its correlation with prognosis.Methods The 350 IS patients admitted to Shaoxing People′s Hospital from January 2017 to December 2020 were selected as the research objects.According to the results of DSA,they were divided into collateral circulation group and non-collateral circulation group.According to the prognosis,they were divided into good prognosis group and poor prognosis group.The consistency between the evaluation results of collateral circulation on IS of TCD and DSA was analyzed,and its correlation with prognosis was analyzed.Results The DSA results showed that among 350 patients,118 had no collateral circulation and 232 had collateral circulation,including 130 cases of grade 1 collateral circulation and 102 cases of grade 2 collateral circulation.TCD results showed that there were 117 cases without collateral circulation and 233 cases with collateral circulation,including 131 cases with grade 1 collateral circulation and 102 cases with grade 2 collateral circulation.The consistency test showed that the evaluation results of TCD on collateral circulation was highly consistent with the gold standard DSA(Kappa>0.9,P<0.05).Repeated measures analysis of variance showed that time-point effects,inter-group effects,time-point and inter-group interaction effects can significantly affect the changes in modified Rankin scale(mRS)scores(P<0.05);and the mRS scores in the collateral circulation group were less than those in the non-collateral circulation group at admission the hospital,discharge of the hospital and 3 months after discharge the hospital:(1.89±0.82)scores vs.(2.98±0.98)scores,(1.13±0.53)scores vs.(2.45±0.80)scores,(0.50±0.45)scores vs.(1.86±0.80)scores,there were statistical differences(P<0.05).The collateral circulation rate in the good prognosis group was higher than that in the poor prognosis group:78.95%(150/190)vs.47.

关 键 词：超声检查 多普勒 经颅 血管造影术 数字减影 缺血性脑卒中 侧支循环 

分 类 号：R743.3[医药卫生—神经病学与精神病学]