腔隙性脑梗死小动脉病变的血流动力学特点研究

Hemorrheological Changes in Lacunar Cerebral Infarction Patients With Arteriopathy of Small Artery

【目的】探讨腔隙性脑梗死中小动脉病变的脑血流动力学特点。【方法】采用经颅多普勒(TCD)观察85例排除伴有明显大血管病变的腔隙性脑梗死患者脑内主要动脉的血流动力学改变,并与年龄和动脉血压等指标进行相关性分析。并设立相同年龄段的头颅影像检查正常的25例健康体检者作为对照。【结果】腔隙性脑梗死组大脑中、前、后动脉的平均血流速度分别为(62.09±16.90)cm.s-1、(50.42±13.11)cm.s-1、(32.33±7.55)cm.s-1,均低于对照组的(69.65±19.20)cm.s-1、(57.75±16.75)cm.s-1、(38.75±8.81)cm.s-1(均P<0.05),脉动指数分别为1.05±0.26、1.01±0.24、1.05±0.23,均高于对照组的0.87±0.12、0.88±0.20、0.88±0.16(均P<0.05)。其中大脑中、前、后动脉的平均血流速度与性别、年龄和动脉血压无明显相关性,而脉动指数与年龄呈正相关(r分别为0.394、0.299、0.352,均P<0.05),大脑前动脉的脉动指数与收缩压和脉压差呈正相关(r分别为0.338、0.353,P<0.05),大脑中动脉的脉动指数与脉压差呈正相关(r=0.220,P<0.05),梗死灶所在的患侧和没有梗死灶的健侧的血流速度和脉动指数均未见显著性差异(P>0.05)。【结论】腔隙性脑梗死患者小动脉病变可导致血流速度轻度减慢,脉动指数升高,其中脉动指数与年龄和动脉血压有一定相关性。

[ Objective] To observe the hemorrheological changes in lacunar cerebral infarction （LCI） patients with arteriopathy of middle and small arteries. [ Methods ] The hemorrheologieal changes of cerebral arteries in 85 LCI patients without arteriopathy of large artery confirmed by cervical vessels color ultrasonography and magnetic resonance image （MRI） were observed by transeranial Doppler uhrasonography （TCD）. The correlation of the hemorrheologieal changes with age and blood pressure （BP） of arteries was investigated. The above indexes were compared with those in 25 healthy volunteers confirmed by eneephalography in the same age group. [ Results] The mean blood flow rates of cerebral middle, anterior and posterior artery in LCI patients were （62.09 ± 16.90 ） cm·s^-1, （50.42 ± 13.11 ） cm·s^-1,and （32.33±7.55） ·s^-1 respeetively, lowerthan （69.65±19.20） cm·s^-1, （57.75±16.75） cm·s^-1, and （38.75±8.81 ） cm·s^-1 respectively in the healthy volunteers （P 〈 0.05）. The pulsating indexes of cerebral middle, anterior and posterior artery in LCI patients were 1.05 ± 0.26, 1.01 ± 0.24, and 1.05 ± 0.23 respectively, higher than 0.87 ± 0.12, 0.88 ± 0.20, and 0.88 ± 0.16 respectively in the healthy volunteers （P 〈 0.05）. The pulsating index of cerebral middle, anterior and posterior artery in LCI patients （the correlation coefficient being 0. 394, 0. 299, 0.352 respectively） was positively correlated with the age （P 〈 0.05）, while the mean blood flow rate was not correlated with sex, age and arterial BP; the pulsating index of cerebral anterior artery was positively correlated with systolic pressure and pulse pressure, the correlation coefficient being 0. 338 and 0. 353 respectively （P 〈 0.05） ; the pulsating index of cerebral middle artery was positively correlated with the difference of pulse pressure, the correlation coefficient being 0.220 （ P 〈 0.05）. No significant difference was found between blood flow rate and pulsating index in the affected and healthy part of brain in LCI patients （P 〉 0.05）. [Conclusion] The arteriopathy of small artery in LCI patients can cause the mild decrease of blood flow rate and the increase of pulsating index. There exists a correlation of pulsating index with age and arterial blood pressure.