超声检测大脑中动脉慢性闭塞患者脑血流与脑梗死的相关性

Correlation between cerebral blood flow and cerebral infarction in patients with chronic middle cerebral artery occlusion detected by ultrasound

目的探讨大脑中动脉慢性闭塞(CMCAO)患者大脑前动脉(ACA)脑膜支代偿(LMA)对脑梗死大小的影响,分析大脑中动脉(MCA)流速与脑梗死面积的相关性。方法回顾性连续纳入2014年6月至2016年6月延边大学附属医院神经内科35例和首都医科大学宣武医院神经内科的CMCAO患者74例,对所有患者采用经颅多普勒超声(TCD)和(或)经颅彩色多普勒超声(TCCS)诊断为一侧CMCAO而对侧MCA正常,并经DSA证实。根据DSA显示ACA有无脑膜支,分为LMA组49例及无LMA组(NLMA)60例。采用TCCS和(或)TCD测量,记录患侧与健侧MCA的收缩期峰值流速(PSV)及平均流速(MFV),并计算健侧、患侧PSV比值(PSV_(健侧)/PSV_(患侧))。根据磁共振扩散加权成像(DWI)检查结果分为脑组织正常、腔隙性脑梗死、中小面积脑梗死及大面积脑梗死4级,采用秩和检验比较LMA组与NLMA组脑梗死面积的差异,并采用Spearman秩相关分析患侧MCA的血流参数与脑梗死面积的相关性。结果 (1)两组患者的患侧与健侧MCA的PSV、MFV及PSV_(健侧)/PSV_(患侧)差异均无统计学意义(均P>0.05)。(2)NLMA组中卒中者占90.0%(54例),明显高于LAM组71.4%(35例),两组间差异有统计学意义(P<0.05);LMA组DWI以腔隙性脑梗死为主(51.0%,25例),NLMA组多以中小面积脑梗死为主(45.0%,27例),并且大面积脑梗死发生率(21.7%,13例)高于LMA组(4.1%,2例),两组差异有统计学意义(P<0.01)。(3)NLMA组患者脑梗死面积与MCA的PSV呈中度负相关(r=-0.736,P<0.01),并随PSV_(健侧)/PSV_(患侧)的升高而增加,呈高度正相关(r=0.849,P<0.01)。结论 CMCAO患者ACA的LMA状态与脑梗死严重程度相关,患侧MCA血流速度的减低与脑梗死面积存在明显相关性。

Objectives To investigate the effect of leptomeningeal anastomoses （LMA） compensation of anterior cerebral artery （ACA） on the size of cerebral infarction in patients with chronic middle cerebral artery occlusion （CMCAO） and to analyze the correlation between middle cerebral artery （MCA） velocity aud cerebral infarction area. Methods From June 2014 to June 2016,35 consecutive patients with CMCAO from the Department of Neurology, YaMbian University Hospital and 74 with CMCAO from the Department of Neurology, Beijing Xuanwu Hospital, Capital Medical University were enrolled retrospectively. All patients were diagnosed as CMCAO on one side and MCA was normal on the other side with transcranial Doppler （TCD） or transcranial color-coded sonography （TCCS） and confirmed by digital subtraction angiography （DSA）. They were divided into either a LMA group （n = 49 ） or a non-LMA （NLMA） group （n = 60） according to the DSA revealed ACA. TCCS and/or TCD were used to measure and record the peak systolic velocity （PSV） and mean flow velocity （MFV） of the contralateral and ipsilateral MCA,and the ratios of bilateral PSV were calculated. They were divided into 4 grades, including normal brain tissue, cerebral lacunar infarction, small and moderate cerebral infarction, and large cerebral infarction according to the findings of diffusion-weighted imaging （DWI）. Mann-Whitney test was used to compare the differences of cerebral infarction areas between the LMA group and the NLMA group, and Spearman rank correlation analysis was used to analyze the correlation between the MCA blood flow parameters of the ipsilateral side and the cerebral infarction area. Results （1） The patients with stroke accounted for 90.0% （n = 54） in the NLMA group, and it was significantly higher than 71.4% （ n = 35） in the LAM group. There was significant difference between the two groups （P 〈 0.05）. （2） The severity of cerebral infarction in the NLMA group was significantly higher than that in the LMA group. DWI revealed that the LMA group was mainly lacunar infarction （51.0% , n = 25）, the NLMA group was mainly small and moderate infarction （45.0% , n = 27 ）, the incidence of large infarction （21.7%, n = 13 ） was higher than that in the LMA group （4.1% ,n = 2）. The difference between the two groups was statistically significant （P 〈 0.01 ）. （3） The cerebral infarction area in patients of the NLMA group showed moderately negative correlation with PSV of MCA （r = -0. 736 ,P 〈 0.01 ）, and increased with the increase of contralateral side of PSV/ipsilateral side of PSV,there was a high positive correlation （r = 0. 849, P 〈 0. 01 ）. Conclusion The compensatory function of meningeal branches of the anterior cerebral artery in patients with CMCAO was associated with the severity of cerebral infarction. The decreased MCA blood flow velocity on the ipsilateral side had a significant correlation with cerebral infarction area.