动态动脉硬化指数与颅内外动脉狭窄的关系研究

Correlations between intracranial and extracranial artery stenosis and ambulatory arterial stiffness index

目的探讨动态动脉硬化指数与颅内、外动脉狭窄的关系。方法入选2010年1月至2012年3月我院缺血性脑血管病患者128例，采用经颅彩色多普勒（TCD）和磁共振血管造影（MRA）和（或）CT血管造影术（CTA）联合诊断颅内、外动脉的狭窄程度及数量，并依照病变程度分无狭窄组、轻度狭窄组、中度狭窄组、重度狭窄组。行24h动态血压监测并计算动态动脉硬化指数（AASI）进行比较分析。结果（1）颅内动脉不同狭窄程度4组在年龄、性别、糖尿病比例、高血压比例、体质量指数（BMI）方面差异无统计学意义（P均〉0．05），而在AASI（无狭窄组0．48±0．15、轻度狭窄组0．624-0．16、中度狭窄组0．614-0．17、重度狭窄组0．644-0．15）中差异有统计学意义（F=3．955，P=0．001）；进一步两两比较发现，轻、中、重度狭窄组的AASI显著高于无狭窄组，差异有统计学意义（P均〈0．05），而轻、中、重度狭窄组之间比较差异无统计学意义。（2）颅外动脉不同狭窄程度4组间年龄、性别、高血压比例、糖尿病比例、BMI方面差异无统计学意义（P均〉0．05），而在AASI（无狭窄组0．48±0．10、轻度狭窄组0．57±0．11、中度狭窄组0．59±0．12、重度狭窄组0．604-0．15）中差异有统计学意义（F=3．643，P=0．002）；进一步两两之间比较发现，轻、中、重度狭窄组的AASI显著高于无狭窄组，差异有统计学意义（P均〈0．05）。不同颅内、外动脉病变支数的AASI比较差异有统计学意义（F=7．395，P〈0．001）；1支、2支、3支及以上病变与0支病变比较，差异有统计学意义（P均〈0．05）。结论AASI是基于24h动态血压监测获得的指标，主要反映动脉硬化对血压的影响，与颅内外动脉狭窄程度有关。AASI可为临床缺血性脑血管病的诊断及治疗效果的预测提供帮助。

Objective To investigate the correlations between ambulatory arterial stiffness index and intracranial/extracranial arterial stenosis. Methods One hundred and twenty-eight cases of ischemic cerebrovascular disease were collected in our hospital from January 2010 to March 2012. Joint diagnosis of cranial computer tomography（TCD） and magnetic resonance angiography （MRA） and, or CT angiography （CTA） were used to detect the degree and number of intracranial arteries, and in accordance with the lesions level, patients were divided into stenosis group, the mild stenosis group, the moderate stenosis group and severe stenosis group. 24 h ambulatory blood pressure was monitored and ambulatory arterial stiffness index （AASI） was calculated and statistically analyzed. Results （ 1 ） Age, sex, hypertension proportion of diabetes, body mass index（BMI） of different Intracranial arterial stenosis in four groups did not have significant differences （P 〉 0. 05 ）, but in AASI the without stenosis group is 0.48 ± 0. 15 ; the mild stenosis group 0.62 ± 0. 16, the moderate stenosis group 0. 61± 0. 17, severe stenosis group 0. 64± 0. 15, and there was significant difference （ F = 3. 955, P = 0. 001 ）. （ 2 ） Age, sex, hypertension proportion of diabetes, BMI of different extracranial arterial stenosis in four groups did not have significant differences （ P 〉 0. 05 ）, but in AASI the without stenosis group was 0. 48 ± 0. 01 ;the mild stenosis group 0. 57± 0. 11, the moderate stenosis 0. 59± 0. 12, and severe group 0. 60 ±0. 15,and there was significant difference（ F = 3. 643, P = 0. 002）. In comparison between any two group：light,moderate and severe stenosis AASI were significantly higher than those without stenosis , and there was significant difference （ P 〈 0. 05 ）. And there was significant different in AASI among different intracranial and extracranial arterial lesions （ F = 7. 395 ,P 〈 0. 001 ）. Compared to 0 branch pathological changes, 1 branch, 2 branch, 3 branch and above, there was was significant difference （ P 〈 0. 05 ）. Conclusion Based on a 24-hour ambulatory blood pressure monitoring indicators, AASI was mainly reflecting the impact of atherosclerosis on blood pressure, associated with intracranial and extracranial artery stenosis. AASI would play a major role in clinical diagnosis and treatment of ischemic cerebrovascular and forecast.