超声评估椎动脉优势所致管径不对称程度与椎动脉起始段狭窄相关性的多中心研究  

A multicenter study of ultrasound assessment of the diameter differences due to vertebral artery dominance and its association with vertebral artery origin stenosis

作　　者：刘一铭 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 Liu Yiming;Zhang Feng;Hua Yang;Carotid Artery Ultrasound Project Group(CAUPC)(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》2024年第11期744-751,共8页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探索无心脑血管病危险因素者椎动脉优势(VAD)所致双侧椎动脉管径不对称程度与椎动脉起始段狭窄(VAOS)发生的相关性及诊断VAD的最佳管径差值(△D)截断值。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”中无高脂血症、高血压病、糖尿病、肥胖(体质量指数≥28 kg/m^(2))、吸烟史、饮酒史等心脑血管病危险因素的非椎动脉闭塞受试者6404例。收集患者年龄、性别、体质量指数、双侧椎动脉管径△D及根据椎动脉起始段和椎间隙段的收缩期峰值流速和舒张末期流速评估的VAOS情况。将狭窄率≥50%的受试者划分为VAOS组,其余为对照组。比较两组一般资料及△D,将其中差异有统计学意义的项目作为自变量,以发生狭窄率≥50%VAOS作为因变量,进一步采用多因素Logistic回归分析,分析其独立影响因素。使用倾向性评分匹配对VAOS组和对照组按1∶5进行匹配,基于匹配后受试者以发生狭窄率≥50%VAOS为结局指标,以△D为自变量绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),以约登指数计算△D的最佳截断值。结果纳入的6404例受试者中,男1975例,女4429例;其中VAOS组46例,VAOS发生率0.72%。(1)单因素Logistic回归分析结果显示,VAOS组的男性比例、年龄、体质量指数及△D均高于对照组(均P<0.05)。将以上变量进一步纳入多因素Logistic回归分析,结果显示,男性(OR=2.49,95%CI:1.36~4.67,P=0.003)、年龄(OR=1.14,95%CI:1.11~1.17,P<0.01)及△D(OR=1.81,95%CI:1.06~2.97,P=0.024)均为发生狭窄率≥50%VAOS的危险因素。(2)倾向性评分匹配后,VAOS组纳入46例,对照组纳入230例,共276例。组间比较结果显示,VAOS组△D高于对照组[0.65(0.30,1.20)mm比0.40(0.20,0.80)mm,P=0.009],余基线资料组间差异均无统计学意义(均P>0.05)。(3)基于倾向性评分匹配后的276例受试者,以发生狭窄率≥50%VAOS为�Objective To investigate the association between vertebral artery origin stenosis(VAOS)and the degree of bilateral vertebral artery diameter asymmetry caused by vertebral artery dominance(VAD)in patients cardiovascular and cerebrovascular disease risk factors and the optimal diameter difference(△D)cutoff value for diagnosing VAD.Methods A total of 6404 subjects without vertebral artery occlusion and risks factors of cerebrovascular disease including hyperlipidemia,hypertension,diabetes,obesity(body mass index[BMI]≥28 kg/m^(2)),smoking history,and drinking history were retrospectively enrolled from the Standardized Evaluation Database for Screening of High-risk Groups for Stroke from December 2019 to December 2021.The age,sex,BMI,bilateral vertebral artery△D,and VAOS evaluated by the systolic peak velocity and end-diastolic velocity of the vertebral artery origin and intervertebral segment were collected.Subjects with stenosis rate≥50%were divided into VAOS group,and the rest were divided into control group.The general data and△D of the two groups were compared.The items with statistically significant differences were enrolled into multivariable Logistic regression analysis in which≥50%VAOS was used as the dependent variable.The VAOS group and the control group were matched at a ratio of 1∶5 using propensity score matching.The receiver operating characteristic(ROC)curve was drawn based on≥50%VAOS as the outcome indicator and△D as the independent variable after matching.The area under the curve(AUC)was calculated.The Youden index was used to calculate the optimal cutoff value of△D.Results Among the 6404 patients included,there were 1975 males and 4429 females.Among them,46 patients were in the VAOS group,and the incidence of VAOS was 0.72%.(1)The results of univariate Logistic regression analysis showed that the male proportion,age,BMI and△D in the VAOS group were higher than those in the control group(P<0.05).The above variables were further included in the multivariate Logistic regression an

关 键 词：椎动脉 超声检查 椎动脉起始段狭窄 椎动脉优势 不对称性 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]