缺血性卒中后认知障碍患者上肢动脉及指端微小血管血流动力学特点分析  

Hemodynamic characteristics of upper limb artery and fingertip micro-vessels in patients with post-ischemic stroke cognitive impairment

作　　者：刘廷琼 陈亚萍 李渝 但思宇 黄多[1] 岳文胜[1] LIU Ting-qiong;CHEN Ya-ping;LI Yu;DAN Si-yu;HUANG Duo;YUE Wen-sheng(Department of Ultrasound,Affiliated Hospital of North Sichuan Medical College,Laboratory of Ultrasound,Sichuan Provincial Key Laboratory of Medical Imaging,Nanchong Key Laboratory of Ultrasound Medical Engineering,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院附属医院超声科·超声研究室,医学影像四川省重点实验室,超声医学工程南充市重点实验室,四川南充637000

出　　处：《川北医学院学报》2024年第12期1696-1700,共5页Journal of North Sichuan Medical College

基　　金：川北医学院附属医院揭榜挂帅项目(2022JB001)。

摘　　要：目的:定性、定量分析缺血性卒中后认知障碍(PSCI)患者从肱动脉至指端微小血管血流动力学特点,初步探索指端微循环状态与PSCI患者认知功能的相关性。方法:选取头部CT/MRI首次诊断为急性缺血性脑卒中,3~6个月复查时认知功能下降者为PSCI组(n=66),头部CT/MRI正常且年龄性别相匹配的志愿者为对照组(n=56)。采用高频超声联合平面波超敏感显像技术(Angio PLUS)获取所有研究对象肱动脉(BA)、桡动脉(RA)、尺动脉(UA)及中指尺侧、桡侧指掌侧固有动脉(UPPDA、RPPDA)的收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)、搏动指数(PI)及指端微小血管分布参数,采用Image J处理指端微小血管分布图片,测量Gray值,并对上述参数进行对比分析。结果:在调整高血压、糖尿病的影响因素后,与对照组相比,PSCI组BA、RA、UA、UPPDA、RPPDA的EDV及UPPDA、RPPDA的PSV均降低(P<0.05),BA、RA、UA、RPPDA、UPPDA的RI、PI均增高(P<0.05),指端微小血管分布等级为Ⅰ级、Ⅱ级的例数增加,为Ⅳ级的例数减少,指端微小血管密度Gray值增高(P<0.05)。Spearman相关性分析发现,MMSE与UPPDA.PI、RPPDA.PI及Gray值负相关,与指端微小血管分布等级正相关(P<0.05)。结论:高频超声联合Angio PLUS技术可定性定量检测PSCI患者从肱动脉至指端水平动脉血流动力学变化及指端血流灌注情况,指端微循环状态能一定程度反映PSCI患者的认知功能。Objective:To analyze the hemodynamic characteristics from brachial artery(BA)to fingertip micro-vessels in patients with post-ischemic stroke cognitive impairment(PSCI),and to explore the correlation between finger microcirculation and cognitive function in PSCI patients.Methods:Patients with acute ischemic stroke diagnosed by head CT/MRI,66 of them with cognitive decline at the 3~6 months follow-up were selected as the PSCI group.56 volunteers with normal head CT/MRI and matching age,sex as the control group.The peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI),pulsation index(PI)of BA,radial artery(RA),ulnar artery(UA),ulnar proper palmar digital artery(UPPDA),radial proper palmar digital artery(RPPDA)and fingertip micro-vessels distribution of all subjects were obtained by high-frequency ultrasound combined with Angio planewave ultrasensitive imaging(Angio PLUS).Image J was used to process the distribution fingertip micro-vessels pictures,measure the Gray-value.Results:After adjusting the influencing factors of hypertension and diabetes,the EDV of BA,RA,UA,UPPDA,RPPDA and the PSV of UPPDA,RPPDA were decreased,the RI,PI of BA,RA,UA,RPPDA,UPPDA were increased,the number of people with gradeⅠandⅡof fingertip micro-vessels distribution increased,and with gradeⅣdecreased,and the Gray-value of fingertip micro-vessels increased in PSCI group(P<0.05).Spearman correlation analysis found that MMSE was negatively correlated with RPPDA.PI,UPPDA.PI,Gray-value,and positively correlated with the distribution grade of fingertip micro-vessels(P<0.05).Conclusion:High-frequency ultrasound combined with Angio PLUS can be used to detect the changes of arterial hemodynamics from brachial artery to fingertip and the perfusion of finger-end in PSCI patients.The microcirculation status of fingertip can reflect the cognitive function of PSCI group to certain extent.

关 键 词：急性缺血性卒中 认知障碍 上肢动脉超声 指端微循环 

分 类 号：R445.1[医药卫生—影像医学与核医学]