超声评估椎动脉起始段狭窄与解剖学因素相关性的多中心分析  

Multicenter data analysis for ultrasound assessment of vertebral artery origin stenosis and anatomical factors

作　　者：张峰 华扬[2] 脑卒中高危人群筛查脑颈动脉规范化评估数据库课题组 Zhang Feng;Hua Yang;Carotid Artery Ultrasound Project Group(CAUPG)(Department of Ultrasound,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China;不详)

机构地区：[1]中山大学附属第六医院超声科,广州510655 [2]首都医科大学宣武医院血管超声科 [3]不详

出　　处：《中国脑血管病杂志》2023年第9期609-615,共7页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的 分析椎动脉起始段狭窄(VAOS)与椎动脉解剖学因素(走行变异、管径和起源情况)的相关性。方法 回顾性连续性纳入2019年12月至2021年12月“脑卒中高危人群筛查脑颈动脉超声规范化评估数据库”中11 255例颈部动脉粥样硬化性病变患者。根据椎动脉血流动力学参数[收缩期峰值流速(PSV)、舒张期末流速(EDV)和PSV_(起始段)/PSV_(椎间隙段)]确定VAOS的程度,分为轻度(狭窄率<50%)、中度(狭窄率50%~<70%)、重度(狭窄率70%~99%)狭窄及闭塞,并依据VAOS的程度将颈部动脉粥样硬化性病变患者分为VAOS组(轻、中、重度狭窄及闭塞)与正常组(无狭窄)。收集患者的一般情况,包括性别、年龄、体质量指数(BMI);椎动脉解剖学因素,包括椎动脉走行变异、起源异常、椎间隙段(V2段)内径;心脑血管疾病相关危险因素,包括高血压病、糖尿病、高脂血症、吸烟史、饮酒史、肥胖(BMI≥28 kg/m~2)。最终统计分析时,若涉及侧别,各组以侧数进行统计,其中双侧颈部动脉粥样硬化病变分别计入左侧和右侧;若未涉及侧别,各组以例数进行统计。以发生VAOS作为因变量,将一般情况、解剖学因素及心脑血管疾病相关危险因素进行单因素Logistic回归分析,并将其中P<0.05的项目作为自变量,进一步采用多因素Logistics回归分析VAOS的独立影响因素。结果 (1)11 255例颈部动脉粥样硬化性病变患者中,剔除基本信息不完整、彩色多普勒超声数据缺失或录入错误者819例,共纳入符合纳排标准的患者10 436例,其中VAOS组547例,正常组9 889例。(2)10 436例颈部动脉粥样硬化性病变患者共20 872侧椎动脉,其中VAOS组634侧(右侧399侧、左侧235侧),右侧VAOS检出率(1.9%)高于左侧(1.1%),两侧差异有统计学意义(χ~2=43.75,P<0.01);正常组20 238侧(右侧10 037侧、左侧10 201侧)。右侧椎动脉的VAOS组均无椎动脉走行变异,V2段内径较正常组粗,两组椎动脉走行变�Objective Analyze the correlation between vertebral artery origin stenosis(VAOS)and anatomical factors(course variation,diameter,and origin).Methods A total of 11255 patients with carotid atherosclerotic lesions in the“standardized evaluation database for cerebral vascular ultrasound screening in the high-risk population of stroke”from December 2019 to December 2021 were included retrospectively and continuously.According to vertebral artery hemodynamic parameters(peak systolic velocity[PSV],end-diastolic velocity[EDV]and PSV initiation segment/PSV intervertebral segment),the degree of VAOS was classified as mild(stenosis rate<50%),moderate(stenosis rate 50%-<70%),severe(stenosis rate 70%-99%)stenosis and occlusion,and according to the degree of VAOS,patients with cervical atherosclerotic lesions were divided into VAOS group(mild,moderate and severe stenosis and occlusion)and normal group(no stenosis).General information were collected including gender,age,body mass index(BMI);vertebral artery anatomy,including vertebral artery course variation,abnormal origin,intervertebral space segment(V2)inner diameter;risk factors associated with cardiovascular and cerebrovascular disease,including hypertension,diabetes,hyperlipidemia,history of smoking,history of alcohol consumption,and obesity(BMI≥28 kg/m 2).In the final statistical analysis,if the side was involved,each group was counted on the case side,and the bilateral cervical atherosclerotic lesions were counted as left and right respectively.If no side differentiation was involved,each group was counted by the number of cases.Taking the occurrence of VAOS as the dependent variable,the general information,anatomical factors and risk factors related to cardiovascular and cerebrovascular diseases were single factor Logistic regression analysis;the items of P<0.05 were used as independent variables,and the independent influencing factors of VAOS were further analyzed by multivariate Logistics regression.Results(1)Among 11255 patients with cervical atherosclerotic

关 键 词：椎动脉 超声 起始段狭窄 走行变异 

分 类 号：R445.1[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]