颅外颈动脉血流动力学变化与缺血性脑血管病的关系

Relationship between hemodynamic changes of extracranial carotid artery and ischemic cerebrovascular diseases

目的探讨颅外颈动脉血流动力学改变与颅内缺血性脑血管病的关系。方法对52例缺血性脑血管患者(患者组)及30名健康志愿者(对照组)行颅外颈动脉超声检查,检查部位包括颈总动脉(CCA)、颈内动脉(ICA)及椎动脉(VA),分析血流动力学指标及多普勒波形的特点。结果①与对照组相比,患者组双侧颈总动脉收缩峰值流速差(ΔCCA-PSV)、双侧颈总动脉阻力指数差(ΔCCA-RI)、双侧颈内动脉收缩峰值流速差(ΔICA-PSV)、双侧颈内动脉舒张末期流速差(ΔICA-EDV)、双侧颈内动脉阻力指数差(ΔICA-RI)及双侧椎动脉阻力指数差(ΔVA-RI)均明显增高(P均<0.05),而双侧ICA及VA收缩期S1与S2段波峰斜率比值的绝对值(LICA-SL1/SL2、RICA-SL1/SL2、LVA-SL1/SL2、RVA-SL1/SL2)均明显减低(P均<0.05);②ROC曲线分析结果显示,ΔICA-PSV、ΔICA-EDV、ΔVA-RI、右侧ICA-SL1/SL2诊断缺血性脑血管病的ROC曲线下面积(AUC)均在0.7以上;③患者组与对照组间ICA及VA多普勒波形的对称性差异有统计学意义(P均<0.05)。结论颅内缺血性脑血管病可致颅外颈动脉血流动力学改变;利用颅外颈动脉多普勒可预测颅内缺血性脑血管病。

Objective To explore the relationship between hemodynamic changes of extracranial carotid arteries and ische mic cerebrovaseular diseases. Methods Totally 52 patients with isehemic cerebrovascular diseases （patient group） and 30 healthy volunteers （control group） underwent carotid artery duplex ultrasonography with the detecting positions as common carotid artery （CCA）, internal carotid artety （ICA） and vertical artery （VA）. The hemodynamic parameters of carotid arteries and the features of Doppler waveform were analyzed. Results （1）Compared with control group, the differences of hemodynamic parameters between bilateral vascular included peak systolic velocity （PSV） and resistance index （RI） of CCA （ACCA-PSV and ACCA-RI）, PSV, end diastolic velocity （EDV） and RI of ICA （△ICA-PSV, △ICA-EDV and △ICA-RI） and RI of VA （AVA-RI） in patient group were higher （all P〈0.05）, while the absdlute value of slope ratio as slope 1/ slope 2 in bilateral ICA and VA （LICA-SL1/SL2, RICA-SL1/SL2, LVA-SL1/SL2 and RVA-SL1/SL2） in patient group were lower than those in control group. （2）ROC curve analysis in diagnosing ischemic cerebrovascular diseases showed that all of the areas under the curve （AUC） of △ICA-PSV, △ICA-EDV, △VA-RI and RICA-SL1/SL2 were above 0. 7. （3）Statistical differences of Dopplor waveform symmetry in ICA and VA were found between patient group and control group （all P〈0.05）. Conclusion The changes of hemodynamics in extracranial carotid artery are related to intracranial vascular dis eases. Dopplor analysis of extracranial carotid arteries can predict the occurrence of intracranial ischemic cerebrovascular diseases.