超声检测脑血管储备功能预测频发短暂性脑缺血发作患者主要脑血管不良事件的价值  

Cerebrovascular reserve in predicting major adverse cerebrovascular events in patients with frequent transient ischemic attack based on ultrasonographic assessment

作　　者：翁文超 骆丹越 WENG Wenchao;LUO Danyue(Department of Ultrasonography,the Affiliated Jinhua Hospital,Zhejiang Uniuersity School of Medicine(Jinhua Municipal Central Hospital),Jinhua 321000,China)

机构地区：[1]浙江大学医学院附属金华医院(金华市中心医院)超声医学科,321000

出　　处：《浙江医学》2023年第13期1371-1375,1388,共6页Zhejiang Medical Journal

基　　金：金华市重大(重点)科学技术研究计划项目(2021-3-138)。

摘　　要：目的分析脑血管储备(CVR)对频发短暂性脑缺血发作(TIA)患者1年主要脑血管不良事件(MACE)发生的预测价值。方法回顾2019年6月至2021年6月金华市中心医院首次确诊频发TIA患者124例。随访1年根据MACE(包括腔隙性脑梗死、缺血性和出血性脑卒中、脑血栓形成以及脑源性死亡)发生与否分为MACE组35例和无MACE组89例。采用经颅多普勒超声(TCD)结合屏气试验测量大脑前动脉、中动脉、后动脉和椎基底动脉收缩期峰值(Vs)、舒张期峰值(Vd)的血流速度和平均血流速度(Vm),计算屏气指数(BHI)、阻力指数(RI)、平均血流速度上升率(RBFV)和CVR。结果MACE组患者较无MACE组年龄增大、双抗血小板应用率下降,Fib和D-二聚体水平升高、APTT缩短(均P<0.05)。CVR参数比较发现,MACE组大脑中动脉Vs、Vd、Vm、BHI、RBFV、CVR-Vs、CVR-Vd和CVR-Vm均低于无MACE组,而RI高于无MACE组(均P<0.05)。多因素logistic回归分析显示,年龄(OR=1.856,95%CI:1.423~2.326,P<0.05)和大脑中动脉CVR-Vm(OR=2.745,95%CI:2.325~3.421,P<0.01)是预测MACE发生的危险因素。ROC曲线分析显示,大脑中动脉CVR-Vs、CVR-Vd和CVR-Vm预测MACE发生的AUC分别为0.769、0.721和0.865,CVR-Vm的AUC最高(P<0.05)。结论频发TIA患者有较高的MACE发生风险,年龄和入院超声检测CVR尤其是大脑中动脉CVR-Vm下降对MACE发生有较高的预测效能,可作为早期评估MACE风险的无创指标。Objective To analyze the predictive value of cerebrovascular reserve(CVR)for one-year major adverse cerebrovascular events(MACE)in patients with frequent transient ischemic attack(TIA).Methods A total of 124 patients with frequent TIA admitted in Jinhua Municipal Central Hospital from June 2019 to June 2021 were enrolled.The MACE occurred in 35 cases(MACE group)and did not occur in 89 cases(non-MACE group)during one-year follow-up.The MACE included lacunar cerebral infarction,ischemic and hemorrhagic stroke,cerebral thrombosis and cerebral death.Transcranial doppler ultrasound(TCD)combined with breath hold test was used to measure peak systolic bolld flow velocity(Vs),peak diastolic velocity(Vd)blood flow velocities and mean blood flow velocity(Vm)of anterior,middle and posterior cerebral artery and vertebrobasilar artery;the breath hold index(BHI),resistance index(RI),rise rate of mean blood flow velocity(RBFV)and CVR were calculated.Results Compared with non-MACE group,the age of MACE group was higher,the application rate of dual antiplatelet therapy was less,the serum levels of Fib and D-dimer were higher,APTT was shorter(all P<0.05).In terms of CVR parameters,the Vs,Vd,Vm,BHI,RBFV,CVR-Vs,CVR-Vd and CVR-Vm of middle cerebral artery were lower;and the RI was higher in MACE group than those in the non-MACE group(all P<0.05).Multivariate logistic regression analysis showed that age(OR=1.856,95%CI:1.423-2.326,P<0.05)and CVR-Vm of middle cerebral artery(OR=2.745,95%CI:2.325-3.421,P<0.01)were independent predictors of MACE.ROC curve showed the AUC of CVR-Vs,CVR-Vd and CVR-Vm of middle cerebral artery for predicting MACE were 0.769,0.721 and 0.865,respectively(P<0.05).Conclusion Frequent TIA patients have a high risk of MACE;age and the ultrasound assessment of CVR parameters,especially the decreased CVR-Vm of middle cerebral artery has a predictive power for MACE.

关 键 词：短暂性脑缺血发作 主要脑血管不良事件 脑血管储备 经颅多普勒超声 

分 类 号：R743.31[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]