颈动脉内膜中层厚度及脑动脉血流动力学与脑卒中的相关性研究

A study on carotid intima-media thickness and cerebral haemodynamics and their correlation to stroke

目的探讨颈动脉内膜中层厚度(IMT)与大脑中动脉血流动力学之间及其与脑卒中的相关性。方法应用彩色多普勒超声和经颅彩色多普勒,检测200例存在脑卒中危险因素患者颈动脉IMT及大脑中动脉血流动力学指标,与200例健康对照组进行比较;每年检测1次,共3次,各组数据为3年的平均值;观察存在脑卒中危险因素患者各组及健康对照组3年脑卒中的发生率。结果 (1)存在脑卒中危险因素的患者各组IMT、IMT与血管腔内径比率(IMT/D)、收缩期与舒张末期血流速度比值(Vs/Vd)、搏动指数(PI)及阻力指数(RI),均明显大于健康对照组(P<0.01);Vd却低于健康对照组(P<0.01)。(2)存在脑卒中危险因素各组患者3年内脑卒中发生率分别为88%、64%、17%、19%,与健康对照组的4%比较有统计学差异(P<0.01)。(3)颈动脉IMT与大脑中动脉Vd呈显著负相关(r=-0.70,P<0.01),与Vs/Vd、PI、RI呈显著正相关(r=0.71,0.69,0.66,P<0.01);IMT/D与大脑中动脉Vd呈显著负相关(r=-0.65,P<0.01),与Vs/Vd、PI、RI呈显著正相关(r=0.66,0.64,0.67,P<0.01)。(4)脑卒中发生率与颈动脉IMT及IMT/D呈正相关(r=0.89,r=0.76,P<0.01);与Vs/Vd、PI、RI呈正相关(r=0.56,r=0.66,r=0.53,P<0.01),与Vd呈负相关(r=-0.41,P<0.01)。结论联合检测颈内动脉IMT与脑动脉血流动力学对于预测脑卒中的发生具有重要临床意义。

Objective To explore the relationship between carotid intima-media thickness（IMT） and brain blood flow and their correlation to cerebral apoplexy. Methods Using color doppler ultrasound and transcranial color doppler,200 cases of patients with cerebral apoplexy risk factors were measured for carotid IMT and brain blood flow mechanics index, to compare to the control group of 200 healthy individuals. The measurements were taken once a year, for three years, and the results were presented as the averages over the three years, during which the incidences of stroke were also recorded in both patient and control groups. Results （ 1 ） IMT, IMT/D, Vs/Vd, PI and RI of the patient group were significantly higher than those of the control group （P 〈 0. 01 ）, while Vd of the patient group was lower than that of the healthy group（ P 〈 0. 01 ）. （2）The incidences of cerebral apoplexy in the patient group over the 3 years were 88% ,64%, 17%, 10%, respectively ,while the control group was only 4% （P 〈 0. Ol ）. （3）Carotid IMT and middlle cerebral artery Vd had significant negative correlation （ r = - 0. 70, P 〈 0.01 ）, while carotid IMT and Vs/Vd, PI, RI had a significant positive correlation （ r = 0. 71,0. 69,0. 66, P 〈 0.01 ）. Moreover, IMT/D and middle cerebral artery Vd had significant negative correlation （ r = - 0. 65, P 〈 0. 01 ） , while IMT/D and Vs/Vd, PI, RI were positively correlated （ r = 0. 66,0. 64,0. 67, P 〈 0. 01 ）. （4） Incidence of stroke had a positive correlation with IMT and IMT/D（ r = 0. 89, r = 0. 76, P 〈 0.01 ） , a positive correlation with Vs/Vd, PI and RI （ r = 0. 56, r = 0. 66, r = 0.53,P 〈0.01）,and a negative correlation with Vd（r = -0.41,P 〈0.01）. Conclusions It is of clinical significance to measure internal carotid IMT and cerebral haemodynamics for predicting the occurrence of cerebral apoplexy.