踝臂指数与缺血性脑卒中患者颅内动脉狭窄的相关性

The research of the efficacy of ankle brachial index in predicting intracalartery stenosis

目的探讨缺血性脑卒中患者踝臂指数(ABI)与颅内动脉狭窄程度、数量、部位以及不同类型缺血性脑卒中的关系。方法选择82例行全脑血管造影(DSA)的缺血性脑卒中患者,所有患者在造影前均进行ABI测量和常规生化检查。按血管狭窄程度及病变血管数量对患者进行分组,并进行中国缺血性脑卒中亚型(CISS)分型,比较颅内动脉狭窄程度、病变数量、部位以及不同类型脑卒中与ABI的关系。运用SPSS 13.5统计学软件进行统计学分析。结果 (1)颅内动脉狭窄组的ABI值(1.00±0.23)较无狭窄组(1.07±0.33)显著降低(t=1.990,P<0.05)。3支及以上病变组与无狭窄组、1支病变组和2支病变组ABI值有显著差异(t=1.684,t=2.441,P<0.05),但无狭窄组(ABI为1.07±0.33)、1支病变组(ABI为1.04±0.11)、2支病变组(ABI为1.02±0.35)之间比较没有显著性差异(t=1.684,t=1.688,t=1.711,P>0.05)。(2)前后循环均狭窄组(0.89±0.08)的患者与无狭窄组(1.07±0.33)、颈内动脉狭窄组(1.02±0.17)、椎基底动脉狭窄组(1.04±0.15)比较ABI水平有显著性降低(t=1.725,t=2.0,t=2.12,P<0.05)。(3)ABI≤0.9时预测重度颅内动脉狭窄的敏感度、特异度、准确度分别为85.4%、92.5%和69.7%。(4)大动脉粥样硬化(LAA)组ABI异常率显著高于穿支动脉疾病(PAD)组(P<0.01),LAA组ABI值(0.89±0.17)显著降低(t=2.639,P<0.01)。结论缺血性脑卒中患者ABI与颅内动脉狭窄严重程度、病变支数、病变部位相关,重度颅内动脉狭窄、3支以上病变以及前后循环系统均狭窄的缺血性脑卒中患者ABI值明显降低。ABI对重度颅内动脉狭窄有较高的预测价值。ABI与LAA有关,与PAD无关。

Objective To study the efficacy of ankle brachial index （ABI） in predicting the intracranial arterial stenosis degress, quantity, location and different types of ischemic stroke. Methods Eighty-two ischemic stroke patients who were referred for digital subtraction angiography （DSA）were studied. All patients underwent ABI and regular biochemical parameters evaluation before DSA. The patients were grouped by stenosis degress and quantity, and classificated according to Chinese ischemic stroke subclassification （CISS）. Analysis of correlation of ankle brachial index （ABI） with intracranial arterial stenosis, quantity, location and different types of ischemic stroke was performed. All data were analyzed by SPSS 13.5 software. Results l. Intracranial arterial stenosis group＇s ABI （ 1. 00 ± 0. 23 ） was significantly lower than those without stenosis group （ 1. 07 ± 0.33 ） （ t = 1. 990, P 〈 0.05）. Severe lesion group and no stenosis group, single-vessel disease group and the two lesions ABI values were significantly different（ t = 1. 684, t = 2. 441, P 〈 0.05 ）, but no stenosis （ ABI = 1.07 ± 0.33 ）, single vessel disease（ ABI.= 1.04 ± 0.11 ）, two disease groups （ AB1 = 1.02 ± 0.35 ） there was no significant difference （ t = 1. 684, t = 1. 688,t = 1.711 ,P 〉 0.05 ）. 2. Before and after the cycle are stenosis groups （0.89 ± 0.08） and no stenosis group （1.07 ± 0.33 ）, carotid artery stenosis （1,02 ±0.17 ）, vertebrobasilar artery stenosis group （1.04 ± 0.15 ） ABI levels were significantly lower（ t = 1. 725,t = 2.0, t = 2.12, P 〈 0.05 ）. 3. ABI ≤0.9 as the prediction of severe intraeranial stenosis has sensitivity, specificity, accuracy of 85.4% ,92.5% 和 69.7%. 4. large artery atherosclerosis （LAA） group was significantly higher than Penetrating artery disease （ PAD ） group （ P 〈 0.01 ） in ABI, LAA group ABI values （0.89 ± 0.17） was significantly lower （ t = 2. 639,P 〈 0.01 ）. Conclusions ABI is related to intracranial arterial stenosis severity, quantity, and location ischemic stroke patients. In severe intracranial stenosis, three or more lesions and stenosis of both anterior and posterior circulations, ABI is significantly lower. ABI has a high predictive value in severe intracranial stenosis. ABI is related to the pathogenesis of LAA,while not to PAD.