双侧椎动脉不对称性与椎动脉起始段狭窄的相关性分析  

Analysis of correlation of bilateral vertebral artery asymmetry and vertebral artery origin stenosis

作　　者：张峰 华扬[2] 刘一铭 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;Liu Yiming;Carotid Artery Ultrasound Project Group(CAUPC)(Department of Ultrasound,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

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》2024年第5期312-318,共7页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的分析无心脑血管疾病危险因素人群的椎动脉不对称性与椎动脉起始段狭窄(VAOS)病变发生的相关性。方法回顾性连续纳入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”中无心脑血管疾病危险因素接受颈部动脉粥样硬化超声筛查者共6423例。收集受试者一般资料,包括性别、年龄、体质量指数(BMI)及左、右两侧椎动脉超声检查参数,即椎间隙段(V2段)内径及采用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]评估的VAOS的程度(轻度、中度、重度及闭塞)。依据检测结果将所有患者分为VAOS组与非VAOS组。将椎动脉内径≤2.0 mm定义为椎动脉发育不良(VAH);将双侧椎动脉V2段内径差值≥1.2 mm定义为椎动脉优势(VAD),并将所有患者分为VAD组和非VAD组(内径差<1.2 mm)。最终统计分析时,若涉及侧别,各组以侧进行统计;若未涉及侧别,各组以例数进行统计。以发生VAOS作为因变量,将一般资料、解剖学因素(VAH、VAD)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Logistic回归分析VAOS的独立影响因素。结果共纳入符合纳排标准的人群6423例,男1985例,女4438例;年龄19~80岁,平均(43±13)岁。其中VAD组628例,非VAD组5795例。(1)与VAD组比较,非VAD组女性占比更高(69.9%比61.3%,P<0.01),年龄更小[(43±13)岁比(45±14)岁,P<0.01],且年龄<40岁人群占比高于VAD组(46.3%比38.4%,P<0.01),VAH患者比例和VAOS发生比例均低于VAD组(分别为0.6%比17.2%和1.5%比4.0%,均P<0.01)。(2)无心脑血管疾病危险因素人群发生VAOS的单因素Logistic回归分析结果显示,VAOS组男性比例、年龄、BMI及VAH和VAD的比例均高于非VAOS组,组间差异均有统计学意义(均P<0.05)。进一步进行多因素Logistic回归分析显示,男性(OR=1.92,95%CI:1.30~2.85,P=0.001)、年龄(OR=1.12,95%CI:1.10~1.Objective To analyze the correlation between vertebral artery asymmetry and vertebral artery origin stenosis(VAOS)lesions in population without risk factors for cardiovascular and cerebrovascular diseases.Methods A total of 6423 participants without cardiovascular and cerebrovascular high-risk factors who underwent cervical atherosclerosis ultrasound screening in the"standardized evaluation database for cerebral vascular ultrasound screening in the high-risk population of stroke"from December 2019 to December 2021 were consecutively enrolled.The general information of the participants was collected before the examination,including gender,age,body mass index(BMI),and bilateral vertebral artery ultrasound parameters,i.e.,the internal diameter of the intervertebral segment(V2 segment)and the degree of VAOS(mild,moderate,severe,and occlusion)assessed by hemodynamic parameters(peak systolic flow velocity[PSV],end-diastolic flow velocity[EDV],and PSV initiation/PSV intervertebral segment).According to the ultrasound results,the participants were divided into VAOS group and no stenosis group(non-VAOS group).Vertebral artery diameter≤2.0 mm was defined as vertebral artery hypoplasia(VAH).According to the difference in the inner diameter of the V2 segment of the bilateral vertebral arteries,the participants were classified as vertebral artery dominance(VAD)group(inner diameter difference≥1.2 mm)and non-VAD group(inner diameter difference<1.2 mm).In the final statistical analysis,if there is a side involved,each group will be counted by the number of cases,and if no side differentiation is involved,each group will be counted by the number of cases.Taking the occurrence of VAOS as the dependent variable,the general information and anatomical factors(VAH,VAD)were analyzed by univariate Logistic regression.The item of P<0.05 was used as the independent variable,and the independent influencing factors of VAOS were further analyzed by multivariate Logistic regression.Results A total of 6423 participants were included,includ

关 键 词：椎动脉 超声 起始段狭窄 椎动脉发育不良 椎动脉优势 

分 类 号：R743[医药卫生—神经病学与精神病学]