后循环缺血患者血管评估价值的研究

Evaluation of the value of angiostenosis for the diagnosis of posterior circulation ischemia

目的探讨颈动脉彩色多普勒超声(colour doppler ultrasound,CDU)、经颅多普勒超声(transcranial doppler,TCD)、CT血管成像(CT angiography,CTA)检查对后循环缺血(posterior circulation ischemia,PCI)血管评估的诊断价值。方法将216例PCI患者分为脑梗死组(86例)和短暂性脑缺血发作(TIA)组(130例),均行颈动脉CDU、TCD及头颈联合CTA检查,比较两组斑块的稳定性及血管狭窄的部位和程度。结果 CTA显示157例(72.7%)298条脑血管异常;后循环血管病变以椎动脉V1段(21.5%)和V4段(17.4%)狭窄最为多见,狭窄程度以重度(47.0%)为主;脑梗死组血管病变发生率为80.2%,高于TIA组的67.7%,脑梗死组血管重度狭窄的比例亦高于TIA组(47.4%vs.25.4%),两者差异均有统计学意义(P<0.05)。132例(61.1%)颈动脉CDU异常;脑梗死组易损斑块的发生率为67.4%,高于TIA组的54.5%,差异有统计学意义(P<0.05)。148例(68.5%)TCD检查异常;脑梗死组侧支循环开放率较TIA组明显减少(19.8%vs.27.7%),差异有统计学意义(P<0.05)。结论 PCI患者的主要血管病变部位在椎动脉V1段和V4段;颈动脉CDU、TCD和CTA联合应用可为PCI的血管评估提供依据。

Objective To study the value of colour doppler ultrasound （CDU）, transcranial Doppler （TCD） and CT angiography （CTA） in the clinical diagnosis of the posterior circulation ischemia （PCI）. Methods A total of 216 patients with PCI were divided into the infarction group （n=86） and the TIA group （n=130）. CDU and TCD was detected and confirmed by CT angiography （CTA）. The location, nature and extent of the vascular lesions were analyzed. Results CTA showed that totally 157 patients suffered from 298 cerebral vascular disease. The vascular stenosis incidence was 72.7% in patients with posterior circulation ischemia （PCI）. The main posterior circulation lesions were located at the first segment （V1） （21.5%） and intracranial segment of VA（Va） （17.4%）. The stenosis degree was severe （61.7%） in the vascular lesions. The incidence of vascular lesions was 80.2% in the infarction group. It was higher than that in the TIA group （67.7%）. The incidence of severe vascular stenosis was 47.4% in the infarction group. It was higher than that in the TIA group （25.4%）. The difference was statistically significant （P 〈 0.05）. Abnormalities of carotid arteries were detected by CDU in 132 cases （61.1%）. The incidence of vulnerable plague was 67.4% in the infarction group. It was higher than that in the TIA group （54.5%）. The difference was statistical significant （P 〈 0.05）. Abnormalities of arteries were detected by TCD in 148 cases （68.5%）. The incidence of collateral circulation in the infarction group was 19.8%, which was lower than that of the TIA group （27.7%）. The difference was statistical significant （P 〈 0.05）. Conclusion The main locations of vascular lesions in PCI patients are extracranial vertebral artery （VI） and intracranial VA （V4）. Ultrasonography, TCD and CTA are useful in the evaluation of the etiological factors of PCI.