经颅多普勒屏气试验联合定量脑电图在急性脑梗死中的预测价值  

Predictive Value of Transcranial Doppler Breath Holding Test Combined with Quantitative Electroencephalogram in Acute Cerebral Infarction

作　　者：何庆芳 张锦玲 陆敏艳 杨静 周红 HE Qingfang;ZHANG Jinling;LU Minyan;YANG Jing;ZHOU Hong(Department of Neurology,Affiliated Jiangsu Shengze Hospital of Nanjing Medical University,Suzhou 215228,China)

机构地区：[1]南京医科大学附属江苏盛泽医院神经内科,江苏苏州215228

出　　处：《医学综述》2023年第5期1004-1009,共6页Medical Recapitulate

基　　金：苏州市“科教兴卫”青年科技项目(KJXW2019071);苏州市吴江区临床医学专家团队引进项目(WJYJTD201802);苏州市吴江区第二批“科教兴卫”项目(WWK201911);江苏盛泽医院“院级科研项目”(SYK201807)。

摘　　要：目的探究经颅多普勒(TCD)屏气试验、定量脑电图(QEEG)在急性脑梗死(ACI)的变化以及两项联合检查在ACI患者中的预测价值。方法选取2018年5月至2019年12月在南京医科大学附属江苏盛泽医院神经内科门诊及住院的58例ACI患者作为观察组,选择同期医院健康体检者45例作为对照组。两组研究对象均进行TCD屏气试验及QEEG检测,得到屏气指数(BHI)值及慢波化比率(DTABR)值,同时对观察组进行Barthel指数评定量表、蒙特利尔认知评估量表(MoCA)评分。分析观察组TCD屏气试验中全脑BHI值与Barthel指数评定量表、MoCA评分的关系,QEEG检测中全脑DTABR值与Barthel指数评定量表、MoCA评分的关系,以及全脑BHI、DTABR值及两者联合对ACI的预测价值。结果观察组左侧大脑中动脉、基底动脉、左侧椎动脉及右侧椎动脉及全脑的BHI值均低于对照组[0.32(0.21,0.44)比0.44(0.27,0.70)、0.45(0.30,0.78)比0.99(0.50,1.28)、0.52(0.36,0.80)比1.07(0.65,1.36)、0.50(0.36,0.83)比1.08(0.51,1.38)、0.46(0.35,0.65)比0.90(0.57,1.04)](P<0.01)。观察组左脑、右脑及全脑的DTABR值均高于对照组[0.96(0.52,1.37)比0.70(0.32,1.04)、0.93(0.46,1.60)比0.67(0.29,0.91)、0.88(0.56,1.51)比0.64(0.30,0.98)](P<0.05或P<0.01)。观察组全脑BHI值与Barthel指数评定量表评分和MoCA评分无相关性(r=-0.167,P=0.209;r=-0.050,P=0.709)。观察组全脑DTABR值与Barthel指数评定量表评分无相关性(r=0.134,P=0.316),与MoCA评分呈正相关(r=-0.369,P=0.004)。TCD检测中的全脑BHI值预测ACI的受试者工作特征曲线(ROC)曲线下面积为0.785,灵敏度为96.6%,特异度为53.3%;QEEG检测中全脑DTABR值预测ACI的ROC曲线下面积为0.656,灵敏度为75.9%,特异度为48.9%;两者联合预测ACI的ROC曲线下面积为0.803,灵敏度为84.5%,特异度为66.7%。结论TCD屏气试验联合QEEG检测对ACI有一定的预测价值,有助于ACI发病前及时干预,具有一定的应用价值。Objective To explore the changes of transcranial Doppler(TCD)breath holding test and quantitative electroencephalogram(QEEG)in acute cerebral infarction(ACI),and the predictive value of the two combined examinations in patients with ACI.Methods 58 patients with ACI in the outpatient and inpatient Department of Neurology of Affiliated Shengze Hospital of Nanjing Medical University from May 2018 to Dec.2019 were included as an observation group,and 45 patients underwent physical examination in the same period as a control group.The subjects in the two groups were tested by TCD breath holding test and QEEG to obtain breath holding index(BHI)value and(delta+theta)/(alpha+beta)ratio(DTABR)value.At the same time,the observation group was scored by Barthel index rating scale and Montreal cognitive assessment(MoCA)scale.The relationship between brain BHI and Barthel index rating scale and MoCA score in TCD breath-holding test,the relationship between brain DTABR and Barthel scale and MoCA scale score in QEEG test,and the predictive value of brain BHI and DTABR value and their combination on ACI were analyzed.Results The values of left middle cerebral artery,bassilar artery,left vertebral artery,right vertebral artery and whole brain BHI in the observation group were lower than those in the control group[0.32(0.21,0.44)vs 0.44(0.27,0.70),0.45(0.30,0.78)vs 0.99(0.50,1.28),0.52(0.36,0.80)vs 1.07(0.65,1.36),0.50(0.36,0.83)vs 1.08(0.51,1.38),0.46(0.35,0.65)vs 0.90(0.57,1.04)](P<0.01).The DTABR values of left brain,right brain and whole brain in the observation group were significantly higher than those in the control group[0.96(0.52,1.37)vs 0.70(0.32,1.04),0.93(0.46,1.60)vs 0.67(0.29,0.91),0.88(0.56,1.51)vs 0.64(0.30,0.98)](P<0.05 or P<0.01).There was no correlation between whole brain BHI and Barthel index rating scale score and MoCA score(r=-0.167,P=0.209;r=-0.050,P=0.709).Whole brain DTABR had no correlation with Barthel index rating scale score(r=0.134,P=0.316),but was positively correlated with MoCA score(r=-0.369,P=0.00

关 键 词：急性脑梗死 屏气试验 定量脑电图 诊断预测 

分 类 号：R742[医药卫生—神经病学与精神病学]