缺血性脑卒中椎动脉颅外段血流动力学与颅内段狭窄性病变的相关性

Correlation of extracranial hemodynamic parameters of vertebral artery with intracranial stenosis in ischemic stroke

目的分析缺血性脑卒中患者椎动脉颅外段血流动力学参数与颅内段狭窄性病变的相关性,探讨其临床诊断价值。方法选取单侧椎动脉颅内段狭窄患者90例,根据头颈部CTA或DSA结果分为轻度狭窄25例、中度狭窄37例及重度狭窄28例。应用彩色多普勒超声检测椎动脉V2段的收缩期峰值流速(PSV)、舒张期末流速(EDV)、血流阻力指数(RI)、时间平均峰值流速(TAPV),计算椎动脉血流量(Q),分析PSV、EDV、RI、Q与椎动脉颅内段狭窄程度的相关性。绘制ROC曲线分析PSV、EDV、RI、Q对椎动脉颅内段狭窄的诊断价值。结果中、重度狭窄患者PSV、EDV、Q均低于轻度狭窄患者,且重度狭窄患者低于中度狭窄患者(均P<0.05);中、重度狭窄患者RI均高于轻度狭窄患者,且重度狭窄患者高于中度狭窄患者(均P<0.05)。相关性分析显示,PSV与轻、中、重度狭窄均呈中度负相关(r=-0.613、-0.607、-0.621,均P<0.05);EDV与轻、中度狭窄均呈中度负相关(r=-0.617、-0.601,均P<0.05),与重度狭窄呈高度负相关(r=-0.828,P=0.001);RI与轻、中、重度狭窄均呈中度正相关(r=0.527、0.604、0.753,均P<0.05);Q与轻、中度狭窄均呈中度负相关(r=-0.609、-0.624,均P<0.05),与重度狭窄呈高度负相关(r=-0.813,P<0.05)。ROC曲线分析显示,PSV、EDV、RI、Q联合诊断椎动脉颅内段狭窄的AUC为0.893(95%CI:0.821~0.965),敏感性为92.8%,特异性为96.7%,高于各参数单独应用的诊断效能。结论缺血性脑卒中患者椎动脉颅外段血流动力学参数与颅内段狭窄均有一定相关,PSV、EDV、RI、Q联合诊断颅内段狭窄性病变具有较高价值。

Objective To analyze the correlation of extracranial hemodynamic parameters and intracranial stenosis in patients with ischemic stroke,and to explore its clinical diagnostic value.Methods Ninety patients with different degrees of stenosis in the intracranial segment of unilateral vertebral artery were selected retrospectively.According to the results of CTA or DSA of head and neck,25 cases were classified as mild stenosis,37 cases as moderate stenosis,28 cases as severe stenosis.The peak systolic velocity(PSV),end diastolic velocity(EDV),resistance index(RI) and time average peak velocity(TAPV) of vertebral artery V2 segment were measured and recorded by color Doppler ultrasound.Meanwhile,the blood flow of vertebral artery(Q) was calculated and the correlation between PSV,EDV,RI,Q and the degree of intracranial stenosis of vertebral artery was analyzed.ROC curve was drawn to analyze the value of PSV,EDV,RI,Q in the diagnosis of intracranial vertebral artery stenosis.Results PSV,EDV and Q of patients with moderate and severe stenosis were lower than those of patients with mild stenosis,and those with severe stenosis were lower than those of patients with moderate stenosis(all P<0.05).RI of patients with moderate and severe stenosis was higher than those of patients with mild stenosis,and that with severe stenosis was higher than that of patients with moderate stenosis(all P<0.05).Correlation analysis showed that PSV were negatively correlated with mild,moderate and severe stenosis(r=-0.613,-0.607,-0.621,all P<0.05).EDV were negatively correlated with mild,moderate and severe stenosis(r=-0.617,-0.601,-0.828,all P<0.05).RI were positively correlated with mild,moderate and severe stenosis(r=0.527,0.604,0.753,all P<0.05).Q were negatively correlated with mild,moderate and severe stenosis(r=-0.609,-0.624,-0.813,all P<0.05).The area under ROC curve of combined diagnosis of PSV,EDV,RI and Q was 0.893(95%CI:0.821-0.965),the sensitivity was 92.8%,the specificity was 96.7%,which were higher than those of single diagnosis of vertebral artery stenosis.Conclusion The hemodynamic parameters of the extracranial vertebral artery in patients with ischemic stroke are correlated with different degrees of intracranial stenosis,and the combined diagnosis of PSV,EDV,RI,Q has a high diagnostic value.