颈部彩色多普勒超声联合经颅彩色多普勒超声在老年急性脑梗死患者颈动脉狭窄诊断中的应用效果  

Application of carotid color Doppler ultrasonography combined with transcranial color Doppler ultra sonography in the diagnosis of carotid artery stenosis in elderly patients with acute cerebral infarction

作　　者：闫灵娟 杨宝林 王佳 Yan Lingjuan;Yang Baolin;Wang Jia(Department of Ultrasound Medicine,The Second Affiliated Hospital of Air Force Medical University,Xi’an 710038,China)

机构地区：[1]空军军医大学第二附属医院超声医学科,陕西西安710038 [2]西安医学院第二附属医院

出　　处：《海军医学杂志》2025年第3期273-279,共7页Journal of Navy Medicine

基　　金：唐都青年自主创新科学基金项目(2023BTDQN022)。

摘　　要：目的 探究颈部彩色多普勒超声(CDU)联合经颅彩色多普勒超声(TCCD)检查对老年急性脑梗死患者颈动脉狭窄的诊断价值。方法 回顾性分析2021年5月至2023年5月于空军军医大学第二附属医院就诊且同时接受颈部CDU、TCCD检查的306例疑似老年急性脑梗死患者临床资料,以数字减影血管造影术(DSA)为检查标准,根据标准将疑似患者分为确诊脑梗死组和非脑梗死组,比较2组患者的CDU参数[颈动脉(狭窄处或颈内动脉)收缩期最大流速(PSV)及舒张末期流速(EDV)]和TCCD参数[同侧大脑后动脉(PCA)血流阻力指数(RI)、搏动指数(PI)]差异,经受试者操作特征(ROC)曲线评估相关参数在急性脑梗死诊断中的效能。根据颈动脉狭窄程度将确诊为急性脑梗死患者分为轻度狭窄组、中度狭窄组和重度狭窄组3个亚组,比较各亚组间CDU参数(PSV、EDV)和TCCD参数(RI、PI)差异,采用ROC曲线评估相关参数在老年脑梗死患者颈动脉狭窄程度评估中的效能。结果 经DSA检查确诊脑梗死患者155例(50.65%),非脑梗死患者151例(49.35%)。急性脑梗死组患者EDV、PSV、RI高于非急性脑梗死组(P<0.05),PI低于非急性脑梗死组(P<0.05)。ROC曲线结果显示,EDV、PSV、RI、PI单独及联合诊断急性脑梗死的曲线下面积(AUC)分别为0.577、0.563、0.644、0.643、0.726(P<0.05)。EDV、PSV、RI变化趋势为重度狭窄组>中度狭窄组>轻度狭窄组,PI变化趋势为轻度狭窄组>中度狭窄组>重度狭窄组,且组间差异均有统计学意义(P<0.05);ROC曲线结果显示,EDV、PSV、RI、PI单独及联合评估急性脑梗死患者颈动脉狭窄程度的AUC分别为0.767、0.802、0.845、0.846、0.952(P<0.05)。结论 颈部CDU联合TCCD对急性脑梗死及颈动脉狭窄均具有良好的诊断评估效能,对临床评估老年急性脑梗死颈动脉狭窄患者应用价值较高。Objective To explore the efficacy of carotid color Doppler ultrasonography(CDU)combined with transcranial color Doppler ultra sonography(TCCD)in the diagnosis of carotid artery stenosis in elderly patients with acute cerebral infarction(ACI).Methods The clinical data of 306 elderly patients with suspected ACI who were admitted to the Second Affiliated Hospital of Air Force Medical University,and received CDU and TCCD from May 2021 to May 2023 were retrospectively analyzed.The result of digital subtraction angiography(DSA)was taken as the gold standard.The patients were assigned to cerebral infarction group or non-cerebral infarction group according to the gold standard.CDU parameters(peak systolic velocity[PSV]and end diastolic velocity[EDV]of the common carotid artery)and TCCD parameters(resistance index[RI]and pulsatility index[PI]of posterior cerebral artery[PCA])were compared between the two groups.According to the degree of carotid artery stenosis,ACI patients were assigned to mild stenosis subgroup,moderate stenosis subgroup or severe stenosis subgroup.CDU parameters(PSV,EDV)and TCCD parameters(RI,PI)were compared among subgroups.The efficacy of related parameters in the diagnosis of ACI and the degree of carotid artery stenosis was evaluated by receiver operating characteristic(ROC)curve.Results There were 155 patients(50.65%)in the cerebral infarction group and 151 patients(49.35%)in the non-cerebral infarction group.The cerebral infarction group had higher EDV,PSV and RI and lower PI than the non-cerebral infarction group(P<0.05).The areas under curve(AUC)values of ROC curves of EDV,PSV,RI,PI and their combination in the diagnosis of ACI were 0.577,0.563,0.644,0.643 and 0.726(P<0.05).The levels of EDV,PSV and RI in the subgroups were as follows:severe stenosis subgroup>moderate stenosis subgroup>mild stenosis subgroup,and the change trend of PI was shown as mild stenosis subgroup>moderate stenosis subgroup>severe stenosis subgroup(P<0.05).The AUC values of ROC curves of EDV,PSV,RI,PI and their combinatio

关 键 词：彩色多普勒超声 经颅彩色多普勒超声 急性脑梗死 老年人 颈动脉狭窄 

分 类 号：R743[医药卫生—神经病学与精神病学]