椎动脉椎间段血流动力学参数评估椎动脉颅内段狭窄性病变的效能及可行性研究  

Feasibility and efficacy of hemodynamic parameters of the intervertebral segment of the vertebral artery in evaluating intracranial stenotic lesions

作　　者：袁晓峰 惠品晶[1,2] 颜燕红[1,2] 张炎 蔡忻懿 Xiaofeng Yuan;Pinjing Hui;Yanhong Yan;Yan Zhang;Xinyi Cai(Department of Neurosurgery&Carotid and Cerebrovascular Ultrasonography,The First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Stroke Center,The First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Ultrasonography,First People's Hospital of Kunshan,Kunshan 215300,China;Department of Neurology,First People's Hospital of Kunshan,Kunshan 215300,China)

机构地区：[1]苏州大学附属第一医院神经外科-颈脑血管超声科,215006 [2]苏州大学附属第一医院卒中中心,215006 [3]昆山市第一人民医院超声科,215300 [4]昆山市第一人民医院神经内科,215300

出　　处：《中华医学超声杂志（电子版）》2024年第4期399-407,共9页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：苏州市2022年度第二十八批科技发展计划(医疗卫生科技创新)项目(SKY2022026);苏州大学技术合作项目(H211064)。

摘　　要：目的分析椎动脉椎间段血流动力学参数变化,探讨其评估椎动脉颅内段狭窄性病变的效能及可行性。方法回顾性连续纳入2019年1月至2022年9月于苏州大学附属第一医院行颈部血管超声检查且经CT血管造影(CTA)和(或)数字减影血管造影(DSA)证实有椎动脉颅内段不同程度狭窄或闭塞者279例作为研究组,并纳入同期行颈部血管超声且结果未见明显异常的98例健康体检者作为对照组。根据椎动脉颅内段狭窄程度将研究组分为轻度狭窄组74例、中度狭窄组36例、重度狭窄位于分出小脑后下动脉(PICA)后组(重度狭窄-PICA后组)31例、重度狭窄位于分出PICA前组(重度狭窄-PICA前组)46例、闭塞位于分出PICA后组(闭塞-PICA后组)48例及闭塞位于分出PICA前组(闭塞-PICA前组)44例。各组患者均应用颈部血管超声测量患侧及健侧椎动脉椎间段的血流参数,包括椎动脉直径(VAD)、收缩期峰值流速(PSV)、舒张期末流速(EDV)、阻力指数(RI)。比较各组双侧椎动脉椎间段各血流参数的差异;计算EDV比值(患侧EDV/健侧EDV),并对对照组右侧与各研究组患侧相邻狭窄程度两组的椎间段血流动力学参数进行比较;应用ROC曲线分析各参数诊断椎动脉颅内段狭窄性病变的敏感度、特异度、准确性,并确定最佳诊断界值;采用Spearman相关分析颅内段严重狭窄程度与后循环缺血性卒中的相关性。结果各组两侧椎间段VAD、PSV、EDV、RI比较,中度及以下狭窄各组中各参数差异均无统计学意义(P均>0.01),而重度及以上狭窄各组中,各参数差异均有统计学意义(P均<0.01)。研究组患侧及对照组右侧相邻两组椎间段血流参数比较,中度及以下狭窄各组中,除对照组与轻度狭窄组EDV外,余各参数差异均无统计学意义(P均>0.01);而中度及以上狭窄各组中,除中度狭窄组与重度狭窄组PSV外,余各参数差异均有统计学意义(P均<0.01)。ROC曲线分析显示,EObjective To analyze hemodynamic parameters of the intervertebral segment of the vertebral artery and investigate the efficacy and feasibility of using these hemodynamic parameters to assess stenotic lesions in the intracranial segment.Methods A total of 279 consecutive patients who underwent carotid ultrasound,computed tomography angiography(CTA),and/or digital subtraction angiography(DSA)and exhibited varying degrees of stenosis or occlusion in the intracranial segment of the vertebral artery between January 2019 and September 2022 at the First Affiliated Hospital of Suzhou University were included as a study group.Furthermore,98 healthy individuals who underwent carotid ultrasound during the same period were included as a control group.The study group was categorized based on the degree of intracranial vertebral artery stenosis into the following groups:74 cases of mild stenosis,36 cases of moderate stenosis,31 cases of severe stenosis occurring after the posterior inferior cerebellar artery(PICA)(severe stenosis-post-PICA group),46 cases of severe stenosis occurring before the PICA(severe stenosis-pre-PICA group),48 cases of occlusion occurring after the PICA(occlusion-post-PICA group),and 44 cases of occlusion occurring before the PICA(occlusion-pre-PICA group).Hemodynamic parameters,comprising vertebral artery diameter(VAD),peak systolic velocity(PSV),end diastolic velocity(EDV),and resistance index(RI),were assessed in all groups.Variations in these parameters between the two sides of the vertebral artery segment were analyzed among the groups.The EDV ratio(EDV on the affected side divided by EDV on the healthy side)was computed.A comparison was made between the right side of the healthy control group and the ipsilateral adjacent stenotic side of each study group concerning the hemodynamic parameters of the intervertebral segment of the vertebral artery.The sensitivity,specificity,and accuracy of each parameter in diagnosing intracranial vertebral artery stenosis were calculated using receiver operating ch

关 键 词：颈动脉 超声检查 椎动脉狭窄 小脑后下动脉 闭塞 

分 类 号：R543[医药卫生—心血管疾病]