脑血管狭窄与血管运动反应性及眩晕的相关性

Association of the cerebrovascular stenosis and the vasomotor reactivity vertigo

目的利用彩色多普勒血流成像技术及经颅多普勒超声探讨脑血管狭窄及血管反应性与眩晕的相关性。方法选取在我院行经颅多普勒超声检查的无其他神经体征的头晕或眩晕患者156例,先选48例健康体检者为正常对照组。于平静呼吸下探查脑血管颅外段及颅内段的血流动力学指标;颈动脉内-中膜厚度(IMT)、斑块、狭窄程度及屏气(>15 s)颈内动脉平均速度(MFV),计算血管运动反应性(VMR)。比较各组间脑血管狭窄、血管运动反应性、颈动脉斑块发生率的差异,对VMR与年龄、血压、空腹血糖、IMT进行多元线性回归分析。结果脑血管狭窄眩晕组明显高于头晕组(P<0.05),单纯椎-基底动脉系统血管狭窄率眩晕组高于头晕组(P<0.05),头晕组、眩晕组VMR明显低于对照组(P=0.001,P=0.003),头晕组、眩晕组颈部血管斑块发生率高于对照组(P=0.009,P=0.004);眩晕组VMR与年龄、收缩压、空腹血糖和颈动脉内-中膜厚度有明显相关性。结论眩晕患者脑血管狭窄率高于头晕患者,且以椎-基底动脉系统为主,头晕及眩晕患者血管运动反应性降低,血管运动反应性与年龄、收缩压、空腹血糖及IMT明显相关。

Objective To evaluate the relationship between dizziness and the stenosis of cerebrovascular,vascular motor reactivity with CDFI and TCD.Methods A total of 204 patients were divided into three groups according to the clinical symptoms,the extracranial segment of the cerebral arteries（CCA,ICA,VA） and intracranial arteries（ACA,MCA,PCA,V-BA） were observed when calm breathe and holding back breath（15 s） with CDFI and TCD.The velocity and vasomotor reactivity were analysed.Results The stenosis of cerebrovascular was higher in vertigo than that of dizziness（P=0.021）,the stenosis of V-BA was magnifant in vertigo（P=0.019）,the vasoreactivity in vertigo and dizziness was significantly lower than that in control（P=0.001,P=0.003）.Carotid artery atherosclerosis plaques was significantly higher in vertigo and dizziness than that in control（P=0.004,P=0.009）.The vasoreactivity of vertigo was associated closely with intima-media thickness,age,blood glucose,the systolic blood pressure.Conclusion The stenosis of the cerebral arteries is higher in vertigo patients than dizziness patients and the stenosis of V-BA is magnifant,the vasomotor reactivity of dizziness and vertigo patients is lower than controls.The vasoreactivity of vertigo is associated closely with blood glucose,the systolic blood pressure,intima-media thickness and age.