ABPM、TCD联合颈动脉血管超声检查诊断早期大脑中动脉粥样硬化伴急性脑梗死的临床价值分析

Clinical value of ABPM,TCD and carotid vascular ultrasonography in the diagnosis of early middle cerebral artery atherosclerosis with acute cerebral infarction

目的探讨动态血压监测(ABPM)、经颅彩色多普勒超声(TCD)联合颈动脉血管超声检查诊断大脑中动脉(MCA)粥样硬化伴急性脑梗死(ACI)患者的临床价值。方法选取2014年7月到2016年1月我院收治的早期MCA粥样硬化伴ACI患者80例作为观察组,选取同期在我院进行健康体检的志愿者80例作为对照组。分别对两组研究对象进行ABPM、TCD及颈动脉血管超声检查分析。结果观察组患者的全天平均收缩压(24h-mSBP)、白天平均收缩压(dm SBP)、夜间平均收缩压(nm SBP)、全天平均脉压(24h-mPP)、白天平均脉压(dm PP)及夜间平均脉压(nm PP)水平均明显高于对照组,晨峰血压异常发生率(66. 25%)明显高于对照组(3. 75%),差异有统计学意义(P <0. 05);两组研究对象的全天平均舒张压(24h-mDBP)、白天平均舒张压(dm DBP)及夜间平均舒张压(nm DBP)比较差异无统计学意义(P> 0. 05)。观察组患者双侧的颈动脉收缩时血管直径(CCA-Ds)、颈动脉内中膜厚度(CCA-IMT)均明显大于对照组(P <0. 05),双侧的大脑中动脉阻力指数(MCA-RI)、大脑中动脉搏动指数(MCA-PI)明显高于对照组(P <0. 05)。观察组患者的斑块出现率(96. 3%)明显高于对照组(26. 3%),血管内斑块数目> 1个的比例(83. 8%)明显高于对照组(22. 5%),不稳定斑块出现率(71. 3%)明显高于对照组(15. 0%),血流速度异常率(86. 3%)明显高于对照组(10. 0%),差异有统计学意义(P <0. 05)。结论进行ABPM、TCD、颈动脉血管超声联合检查能同时反映出机体的昼夜血压变化情况、血流动力学参数及动脉粥样硬化程度,为早期诊断MCA粥样硬化伴ACI提供参考。

Objective To investigate the clinical value of dynamic blood pressure monitoring(ABPM),transcranial color Doppler ultrasound(TCD) and carotid artery ultrasonography in the diagnosis of middle cerebral artery(MCA) atherosclerosis with acute cerebral infarction(ACI). Methods 80 patients with early MCA atherosclerosis and ACI admitted to our hospital from July2014 to January 2016 were selected as observation group. 80 volunteers who underwent healthy physical examination in our hospital were selected as the control group. ABPM,TCD and carotid vascular ultrasound were performed and analyzed. Results The whole-day mean systolic blood pressure(24h-mSBP),daytime mean systolic blood pressure(dm SBP),nighttime mean systolic blood pressure(nm SBP),whole-day mean pulse pressure(24h-mPP),daytime mean pulse pressure(dm PP) and nighttime mean pulse pressure(nm PP) of the observation group were significantly higher than that of the control group,the abnormal incidence of morning blood pressure(66. 25%) was significantly higher than that of the control group(3. 75%),and the difference was statistically significant(P < 0. 05). There were no significant differences in whole-day mean diastolic blood pressure(24h-mDBP),daytime mean diastolic blood pressure(dm DBP) and nighttime mean diastolic blood pressure(nm DBP) between the two groups(P > 0. 05). Both sides of carotid artery systolic diameter(CCA-Ds) and carotid intima-media thickness(CCA-IMT) of the observation group were significantly higher in the observation group than in the control group(P < 0. 05). The bilateral middle cerebral artery resistance index(MCA-RI),middle cerebral artery pulsation index(MCA-PI) were significantly higher than the control group(P < 0. 05). The incidence of plaque in the observation group(96. 3%) was significantly higher than that in the control group(26. 3%),and the proportion of intravascular plaques > 1(83. 8%) was significantly higher than that in the control group(22. 5%),the incidence rate(71. 3%) was significantly higher than that of the control group(15. 0%),and the abnormal rate of blood flow velocity(86. 3%) was significantly higher than that of the control group(10. 0%). The difference was statistically significant(P < 0. 05). Conclusion The combined examination of ABPM,TCD and carotid vascular ultrasound can reflect the changes of day and night blood pressure,hemodynamic parameters and atherosclerosis of the body,and provide reference for early diagnosis of MCA atherosclerosis with ACI.