脑动脉硬化患者合并椎动脉异常的临床筛查探讨

Clinical screening of patients with cerebral arteriosclerosis combined with vertebral artery abnormalies

目的:探讨以椎动脉数字减影血管造影(DSA)为参照标准,椎动脉超声、经颅多普勒(TCD)、磁共振动脉造影(MRA)、计算机体层动脉造影(CTA)对脑动脉硬化患者合并椎动脉异常的临床筛查、诊断价值。方法:对2006年1月至2010年9月收治的186例脑动脉硬化患者进行回顾性分析,男133例,女53例;年龄30～84岁,平均63.8岁。186例全部行DSA椎动脉造影,172例行椎动脉超声和TCD,53例行MRA,25例行CTA,以DSA椎动脉造影阳性为病例组,阴性为对照组,分别计算4种检查方法的灵敏度、特异度和一致率。结果:DSA、椎动脉超声、TCD、MRA、CTA检查发现椎动脉异常率分别为50.00%(93/186)、30.81%(53/172)、49.42%(85/172)、15.10%(8/53)、40.00%(10/25)。以DSA椎动脉造影为参照标准,超声检查的灵敏度50.57%,特异度89.41%,一致率69.77%;TCD的灵敏度68.48%,特异度72.50%,一致率70.35%;MRA的灵敏度21.43%,特异度92.00%,一致率54.72%;CTA的灵敏度63.64%,特异度78.57%,一致率72.00%。结论:椎动脉超声、TCD、MRA、CTA4种方法根据患者综合情况,合理、联合应用,有助于全面客观地诊断伴有动脉硬化患者的椎动脉异常。对明确有脑血管疾病的患者进行潜在的颈椎手法推拿,需引起高度警惕,可能会出现椎动脉损伤而造成并发症。

Objective：To explore the clinical screening and value of vertebral artery ultrasound,Transcranial doppler （TCD）,Magnetic resonance angiography（MRA）and Computed tomography angiography（CTA） in the diagnosis of cerebral arteriosclerosis combined with vertebral artery abnormalies according to vertebral artery digital subtraction angiography （DSA）.Methods：From January 2006 to September 2010,186 patients with cerebral arteriosclerosis were retrospectively analyzed. Among the patients,133 cases were males and 53 cases were females,ranged from 30 to 84 years（with a mean of 63.8 years）. All the patients were estimated by DSA;172 cases were estimated vertebral artery ultrasound and TCD;53 cases were estimated by MRA;25 cases were estimated by CTA. The positive results by DSA were seen as case group,while the negative results were seen as control group. The sensitivity,specificity and concordance rate among four groups were calculated. Results：The abnormality rate of vertebral artery with DSA,vertebral artery ultrasound,TCD,MRA and CTA separately was 50.00%（93/186）,30.81%（53/172）,49.42%（85/172）,15.10%（8/53）and 40.00%（10/25）. According to DSA standard,the sensitivity of vertebral artery ultrasound in diagnosing was 50.57%,the specificity was 89.41 %,and concordance rate was 69.77%;while the sensitivity of TCD was 68.48%,the specificity was 72.50%,and concordance rate was 70.35 %;the sensitivity of MRA was 21.43%,specificity was 92.00 %,and concordance rate was 54.72%;the sensitivity of CTA was 63.64%,the specificity was 78.57%,and concordance rate was 72.00%. Conclusion：The reasonable and combined application of vertebral artery ultrasound,TCD,MRA and CTA is helpful for diagnosing cerebral arteriosclerosis combined with vertebral artery abnormalies. For the patients with cerebrovascular disease,cervical massage technique should be paid highly attention,which may cause vertebral artery injury and other complications.