经颅多普勒及颈动脉超声在脑动脉硬化患者中的诊断效果及其与认知功能的相关性研究

Study on the diagnostic effect of transcranial Doppler and carotid ultrasound in patients with cerebral arteriosclerosis and its correlation with cognitive function

目的:探讨经颅多普勒和颈动脉超声在脑动脉硬化患者中的诊断效果及其与认知功能的相关性。方法:选取医院收治的169例疑似脑动脉硬化患者,所有患者均行经颅多普勒和颈动脉超声检查;采用蒙特利尔认知评估量表(MoCA)对患者认知功能进行评估,并对经颅多普勒和颈动脉超声指标与MoCA总分进行相关性分析。结果:169例疑似脑动脉硬化患者经颅多普勒超声确诊脑动脉硬化115例,非脑动脉硬化54例,确诊率为68.05%;颈动脉超声检查确诊脑动脉硬化123例,非脑动脉硬化46例,确诊率为72.78%。脑动脉硬化患者大脑中动脉(MCA)和基底动脉(BA)中舒张末期血流速度(Vd)、平均血流速度(Vm)均低于非脑动脉硬化患者(t_(MCA)=6.912,t=5.324;t_(A)=4.091,t=3.596;P<0.05);血管搏动指数(PI)和血管阻力指数(RI)指数均高于非脑动脉硬化患者(t_(MCA)=4.989,t=4.115,t;=5.023,t=4.026;P<0.05)。脑动脉硬化患者左颈内动脉(LICA)、右颈内动脉(RICA)、左椎动脉(LVA)及右椎动脉(RVA)下PI及RI水平均高于非脑动脉硬化患者(t;=7.092,t=4.451,t=5.998,t=6.132;t;=4.356,t=6.793,t=6.119,t=7.913;P<0.05);受试者工作特征(ROC)曲线结果表明,经颅多普勒联合颈动脉超声诊断脑动脉硬化的ROC曲线下的面积(AUC)为0.894,灵敏度为89.47%,高于单一经颅多普勒及颈动脉超声;特异度为60.43%,低于单一经颅多普勒及颈动脉超声;脑动脉硬化患者记忆能力、语言流畅能力、执行能力、注意力和视空间功能、命名能力、定向力及抽象概况能力MoCA评分以及总分均低于非脑动脉硬化患者(t=6.793,t=5.561,t=7.836,t=6.561,t=9.587,t=7.957,t=6.561,t=5.896;P<0.05);Pearson相关性结果表明,脑动脉硬化患者MoCA总分与Vd和Vm呈负相关性(r=-0.703,r=-0.726;P<0.05);与PI和RI及颈动脉超声LICA、RICA、LVA及RVA呈正相关性(r=0.697,r=0.713,r=0.701,r=0.846,r=0.722,r=0.698;P<0.05)。结论:经颅多普勒联合颈动脉超声用于脑动脉硬化患者中能获得较高的诊断灵敏度及特异度,且与认知功能存在强相关性,对临床诊疗具有一定的价值。

Objective:To investigate the diagnostic effect of transcranial Doppler and carotid ultrasound in patients with cerebral arteriosclerosis and its correlation with cognitive function.Methods:169 patients with suspected cerebral arteriosclerosis who admitted to hospital were selected as subjects.All patients underwent transcranial Doppler and carotid ultrasound examinations.The Montreal cognitive function(MoCA) scale was adopted to assess the cognitive function of patients,and the correlation analysis was performed for the indexes of transcranial Doppler and carotid ultrasound and the total score of MoCA.Results:In 169 patients,115 cases were confirmed as cerebral arteriosclerosis by transcranial Doppler ultrasound,and 54 cases were confirmed as non-cerebral arteriosclerosis by that,and the confirmed rate of that was 68.05%.And 123 cases were confirmed as cerebral arteriosclerosis by carotid ultrasound,and 46 cases were confirmed as non-cerebral arteriosclerosis by that,which confirmed rate was 72.78%.The end diastolic velocity(Vd) and mean velocity(Vm) of middle cerebral artery(MCA) and basilar artery(BA) in the brain of patients with cerebral arteriosclerosis were significantly lower than those of patients without cerebral arteriosclerosis(t_(MCA)=6.912,t=5.324,t;=4.091,t=3.596,P<0.05).And the pulsatility index(PI) and resistance index(RI) of blood vessel of patients with cerebral arteriosclerosis were significantly higher than those of patients without cerebral arteriosclerosis(t_(MCA)=4.989,t=4.115,t;=5.023,t=4.026,P<0.05).The levels of PI and RI under left internal carotid artery(LICA),right internal carotid artery(RICA),left vertebral artery(LVA) and right vertebral artery(RVA) of patients with cerebral arteriosclerosis were significantly higher than those of patients without cerebral arteriosclerosis(t;=7.092,t=4.451,t=5.998,t=6.132,t;=4.356,t=6.793,t=6.119,t=7.913,P<0.05).The results of receiver operating characteristics(ROC) curve indicated that the area under curve(AUC) of ROC and sensitivity of transcranial Doppler combined with carotid ultrasound were 0.894 and 89.47% in diagnosing cerebral arteriosclerosis,respectively,which were higher than those of single transcranial Doppler and single carotid ultrasound.The specificity of combined diagnosis was 60.43%,which was lower than that of single transcranial Doppler and single carotid ultrasound,respectively.The MoCA scores and total scores of memory ability,word fluency ability,executive capacity, attention and view space function,naming ability,orientation ability and abstraction survey ability of patients with cerebral arteriosclerosis were significantly lower than those of patients without cerebral arteriosclerosis(t=6.793,t=5.561,t=7.836,t=6.561,t=9.587,t=7.957,t=6.561,t=5.896,P<0.05).The results of Pearson correlation showed that the total score of MoCA was negatively correlated with Vd and Vm in patients with cerebral arteriosclerosis(r=-0.703,r=-0.726,P<0.05),respectively.And the total score of MoCA was positively correlated with PI,RI,LICA,RICA,LVA and RVA of carotid ultrasound(r=0.697,r=0.713,r=0.701,r=0.846,r=0.722,r=0.698,P<0.05).Conclusion:Transcranial Doppler combined with carotid ultrasound can obtain higher diagnostic sensitivity and specificity in patients with cerebral arteriosclerosis,and it has a strong correlation with cognitive function,which has a certain value in clinical diagnosis and treatment.