烟雾病及烟雾综合征患者颈内动脉颅外段阻力指数的变化及其初步原因分析

Changes of Resistance Index of Extracranial Segment of Internal Carotid Artery and Its Preliminary Analysis in Patients with Moyamoya Disease and Moyamoya Syndrome

目的使用彩色多普勒超声观察烟雾病及烟雾综合征患者的颈内动脉颅外段(eICA)血流动力学参数的改变并探讨其原因。方法本研究纳入DSA确诊的烟雾病及烟雾综合征患者48例,共90侧eICA及眼动脉,分别检查并测量其eICA的阻力指数(RI)、眼动脉的收缩期峰值流速(PSV)及搏动指数(PI)。结果所有90侧eICA中,RI降低(A组:RI≤0.5)、RI正常(B组:0.5<RI<0.7)和RI增高(C组:RI≥0.7)者分别为30例(33.3%)、53例(58.9%)和7例(7.8%),其眼动脉的PI分别为(0.88±0.23)、(1.11±0.26)、(1.04±0.20),差异有统计学意义(P<0.001)。结论由于眼动脉的代偿分流,大部分烟雾病及烟雾综合征患者eICA的RI仍然保持正常,部分患者甚至出现降低。眼动脉是MMD及MMS患者重要的侧支代偿通路,其不同程度的代偿作用明显影响eICA的超声表现。

Objective To observe hemodynamic changes of extracranial internal carotid arteries(eICA)in patients with moyamoya disease and moyamoya syndrome by color doppler ultrasound and explore causes.Methods 48 patients with moyamoya disease and moyamoya syndrome diagnosed by DSA were included with 90 sides of eICAs and ophthalmic arteries.Resistance index(RI),peak systolic velocity(PSV)and pulsatility index(PI)of eICAs were measured.Results Among 90 eICAs,decreased RI(group A:RI≤0.5)was 30 cases(33.3%),normal RI(group B:0.5<RI<0.7)was 53 cases(58.9%),increased RI(group C:RI≥0.7)was 7 cases(7.8%).PI of ophthalmic arteries were(0.88±0.23),(1.11±0.26)and(1.04±0.20),respectively,with significant differences(P<0.001).Conclusion Because of compensatory shunt of ophthalmic arteries,RI of eICA in most patients with moyamoya disease and moyamoya syndrome remains normal,while some patients decreased.Ophthalmic arteries is an important collateral compensatory pathway for patients with MMD and MMS,and its different degrees of compensation significantly could affect ultrasonic manifestations of eICA.