超声检测无症状性脑梗死脑血流动力学指标变化的临床意义

Clinical significance of cerebrovascular hemodynamic index with ultrasound in silent cerebral infarction

目的观察无症状性脑梗死患者脑血管血流动力学指标(CVHI)变化的临床意义。方法回顾性纳入180例行超声检测脑血管血流动力学和头部MRI检查的研究对象,分为3组,60例无症状性脑梗死患者作为无症状性脑梗死(SCI)组,年龄、性别及既往史与之相匹配的有脑血管病高危因素者60例作为脑血管病高危因素(CV-HRF)组,60名同期体检的健康者作为对照组。采用脑血管功能检测仪在双侧颈动脉处采集CVHI,分析比较3组对象CVHI的特征。结果 SCI组、CV-HRF组分别与对照组比较,脑血管血流动力学各项指标差异均有统计学意义,反映脑血管供血状态的指标,包括平均血流量、平均血流速度、最大血流速度、最小血流速度均明显减慢(均P<0.05);反映血管弹性特征和阻力状况的指标,包括脉搏波速、特性阻抗、外周阻力、动态阻力均明显上升(均P<0.05);反映脑微循环的指标差压下降、临界压力明显上升,差异均有统计学意义(均P<0.05);脑血管功能总积分明显下降,分别为(44±9)、(51±5)、(85±7)分,3组总积分值比较差异有统计意义(P<0.05)。结论 SCI和CV-HRF患者均出现CVHI变化,脑血管功能总积分值下降,SCI患者更明显,提示CVHI检测对卒中的发生可显示出较好的预警作用。

Objective To observe the clinical significance of cerebrovascular hemodynamic index（ CVHI） in the patients with silent cerebral infarction. Methods A total of 180 patients performed cerebrovascular hemodynamics with ultrasound and head MRI examinations were enrolled retrospectively.They were divided into three groups： 60 patients with silent cerebral infraction（ SCI） were used as a SCI group,60 age-,sex- and previous medical history-matched high risk patients with cerebrovascular disease were used as a cerebrovascular disease risk factor（ CV-HRF） group,and 60 healthy subjects were used as a normal control group over the same period. Cerebrovascular function detector was used to collect CVHI at the bilateral carotid arteries. The CVHI features of the 3 groups were analyzed and compared.Results Compared with the control group,there were significant changes in various indexes of cerebral vascular hemodynamics in the SCI group and the CV-HRF group. The indexes of reflecting the cerebral blood supply state included significantly decreased mean blood flow,mean flow velocity,maximum flow velocity,and minimum flow velocity（ P 0. 05）; the indexes reflecting vascular elastic properties and resistance status included the increased pulse wave velocity,characteristic im pedance,peripheral resistance,and dynam ic resistance（ P 0. 0 5）; the indexes reflecting cerebral m icrocirculation included significantly increased critical pressure and decreased differential pressure（ P 0. 05）; the total score of cerebrovascular function was also decreased significantly,they were 4 4 ± 9,5 1 ± 5,and8 5 ± 7,respectively（ P 0. 0 5）; there were significance differences in the distribution of total score among the 3 groups（ P 0. 05）. Conclusion The high-risk patients with silent cerebral infarction and cerebrovascular disease have the CVHI changes. The total integrated value of cerebrovascular function declined,and the former is more obvious.