基于个体化计算机流体动力学方法评估阿尔茨海默病脑血流动力学改变  

Evaluation of cerebrovascular hemodynamics in Alzheimer disease patients with a new individual computational fluid dynamics algorithm

作　　者：顾子言 谢健 程载恒 顾丽华[2] 吴伯凯 张高嘉 陈荣亮[3] 张志珺[2] GU Ziyan;XIE Jian;CHENG Zaiheng;GU Lihua;WU Bokai;ZHANG Gaojia;CHEN Rongliang;ZHANG Zhijun(Zhongda Hospital,Nanjing 210009,China.)

机构地区：[1]东南大学医学院,南京210009 [2]东南大学附属中大医院神经内科 [3]中国科学院深圳先进技术研究院先进计算与数字工程研究所

出　　处：《中国神经精神疾病杂志》2023年第5期257-262,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：江苏省医学杰出人才(编号:JCRCA2016006)。

摘　　要：目的基于阿尔茨海默病(Alzheimer disease,AD)患者和认知功能正常对照者影像学数据构建个体化计算机流体动力学(computational fluid dynamics,CFD)模型,并定量评估受试者脑血流动力学状态及其对AD的诊断效能。方法纳入AD患者30例及认知功能正常的对照34名,基于磁共振血管成像(magnetic resonance angiography,MRA)重建其几何动脉树,结合颈/椎动脉超声血流动力学参数以及同步动脉血压构建个体化CFD模型,以模拟其血流状态并计算相关动力学指标。结果AD组与对照组相比,年龄[(75.33±8.93)岁vs.(68.12±10.73)岁]、体质指数[(22.89±3.41)kg·m^(-2)vs.(24.48±2.90)kg·m^(-2)]、尿酸[(265.17±80.36)μmmol·L^(-1)vs.(323.15±89.70)μmmol·L^(-1)]、白蛋白[(38.29±4.22)g·L^(-1)vs.(40.46±3.62)g·L^(-1)]、脑血流量(cerebral blood flow,CBF)[(10.14±3.10)cm^(3)·s^(-1)vs.(12.73±3.42)cm^(3)·s^(-1)]、脑血管阻力(cerebrovascular resistance,CVR)[(10.72±4.12)dyn·s·cm^(-5)·1000 vs.(8.21±2.38)dyn·s·cm^(-5)·1000]的差异有统计学意义(P<0.05)。AD组颅内动脉血管体积分别与CBF(r=0.493,P=0.006)和颅内血管出口数目(r=0.519,P=0.003)呈正相关,CVR与CBF呈负相关(r=-0.826,P<0.001)。logistic回归分析显示,AD患病与年龄(OR=1.083,95%CI:1.014~1.157,P=0.017)和CBF(OR=0.803,95%CI:0.652~0.989,P=0.039)有关联。ROC曲线分析显示,CVR、CBF区分两组的曲线下面积分别为0.687、0.709(P<0.05)。结论年龄增加和CBF减少是AD独立危险因素。个体化CFD模型测定的CVR升高和CBF减低对AD诊断具有价值,该无创、无放射性定量测定脑血流动力学的方法值得临床推广。Objective This study aims to exploit a computational fluid dynamics(CFD)model by static and dynamic parameters,which can be used to detect individual cerebrovascular hemodynamics quantitatively.Methods Patients(n=30)with Alzheimer disease(AD)and controls(n=34)with normal cognitive function were included.The geometric arterial tree was reconstructed based on magnetic resonance angiography(MRA).Combined with carotid/vertebral artery ultrasound hemodynamic parameters and synchronous arterial blood pressure,an individual CFD model was constructed to simulate the blood flow state and calculate the related dynamic indexes.Results Compared with the control group,the AD patients had reduced body mass index(BMI),uric acid,albumin and cerebral blood flow(CBF)(P<0.05),increased age and cerebral vascular resistance(CVR)(P<0.05).The cerebral arterial volume was positively correlated with the CBF(r=0.493,P=0.006)and the number of outlet(r=0.519,P=0.003),respectively.The CVR was negatively associated with the CBF(r=-0.826,P<0.001).The increased age(OR=1.083,95%CI:1.014~1.157,P=0.017)and reduced CBF(OR=0.803,95%CI:0.652~0.989,P=0.039)were independently associated with AD.The results of receiver operating characteristic curve(ROC)show that CBF(AUC=0.687)and CVR(AUC=0.709)could differentiate the AD patients and control group(P<0.05).Conclusion The increased age and reduced CBF may be independent risk factors for AD.The CBF and CVR can differentiate AD patients and control group reliably.Although all simulated indexes only represent the true hemodynamics indirectly,this CFD model can provide patient-specific hemodynamic alterations non-invasively and non-radioactively.

关 键 词：阿尔茨海默病 计算机流体动力学 脑血流量 磁共振成像 脑血流动力学 脑血管阻力 认知功能障碍 

分 类 号：R749.16[医药卫生—神经病学与精神病学]