缺血性脑卒中TCD检查评估脑血流动力学与患者认知功能及近期预后的关系

Relationship between cerebral hemodynamics and cognitive function and short-term prognosis by TCD examination in patients with ischemic stroke

目的:探讨缺血性脑卒中(IS)患者经颅多普勒超声(TCD)检查评估脑血流动力学与认知功能及近期预后的关系。方法:选取80例IS患者为研究对象,分别于急性发病后的第3天急性期阶段及随访3个月康复期阶段,通过TCD检查评估大脑中动脉血流速度(Vm)、阻力指数(RI)、搏动指数(PI)、屏气指数(BHI);蒙特利尔认知(MoCA)量表评估患者康复期认知功能;改良Rankin量表(mRS)评估患者预后,分析血管血流动力学指标与认知功能和近期预后的关系及对预测预后不良的价值。结果:康复期Vm、BHI水平较急性期升高(P<0.05),PI、RI水平较急性期降低(P<0.05)。认知功能障碍与非认知功能障碍患者急性期血流动力学参数Vm、PI、RI、BHI水平比较,差异无统计学意义(P>0.05);认知功能障碍患者康复期大脑中动脉PI、RI水平高于非认知功能障碍患者(P<0.05),BHI水平低于非认知功能障碍患者(P<0.05)。随访3个月,预后良好患者急性期PI、RI水平低于预后不良患者(P<0.05),BHI水平高于预后不良患者(P<0.05);预后良好患者康复期Vm、BHI水平高于预后不良患者(P<0.05),PI、RI水平低于预后不良患者(P<0.05)。相关性分析结果显示,患者mRS评分与康复期Vm、BHI水平呈负相关(r=-0.297、-0.379,P<0.05),与PI、RI、水平呈正相关(r=0.316、0.323,P<0.05)。康复期大脑中动脉PI、RI水平与认知功能障碍MoCA量表评分呈负相关,BHI水平与MoCA量表评分呈正相关(r=-0.324、-0.406、0.383,P<0.05)。ROC曲线分析显示,IS患者急性期大脑中动脉PI、RI、BHI水平预测患者预后不良的曲线下面积(AUC)为0.803,高于3项指标单独评估(P<0.05)。结论:IS患者康复期Vm、BHI水平较急性期升高,PI、RI水平较急性期降低,急性期PI、RI、BHI水平可在一定程度可预测评估患者预后状态,康复期高PI、RI与低BHI水平与患者认知功能障碍和不良预后相关。

Objective:To evaluate the relationship between cerebral hemodynamics and cognitive function and short-term prognosis in patients with ischemic stroke(IS)by transcranial Doppler ultrasound(TCD).Methods:80 patients with IS were evaluated by TCD at the 3 d after acute onset acute and at the 3-month rehabilitation stage,respectively.The middle cerebral artery blood flow velocity(Vm),resistance index(RI),pulsation index(PI)and breath-holding index(BHI)were evaluated by TCD.Montreal cognitive scale(MoCA)was used to evaluate the cognitive function in patients during rehabilitation.The patients'prognosis was evaluated by the modified Rankin Scale(mRS),and the relationship between the vascular hemodynamics and cognitive function and short-term prognosis was analyzed,as well as their value in predicting poor prognosis.Results:The levels of Vm and BHI in IS patients during rehabilitation were higher than those in acute stage,while the levels of PI and RI were lower than those in acute stage(P<0.05).There was no statistically significant difference in the levels of hemodynamic parameters Vm,PI,RI and BHI in patients with cognitive dysfunction and non-cognitive dysfunction at acute stage(P>0.05).The levels of PI and RI in middle cerebral artery in patients with cognitive dysfunction were higher than those in patients with non-cognitive dysfunction,and the levels of BHI were lower than those in patients with non-cognitive dysfunction during rehabilitation(P<0.05).After 3 months of follow-up,PI and RI levels in the patients with good prognosis were lower than those in the patients with poor prognosis at acute stage,while BHI levels were higher than those in the patients with poor prognosis(P<0.05).The levels of Vm and BHI in patients with good prognosis during rehabilitation were higher than those in patients with poor prognosis,and the levels of PI and RI were lower than those in patients with poor prognosis(P<0.05).Pearson correlation analysis showed that mRS Score was negatively correlated with Vm and BHI levels during rehabilitation(r=-0.297,-0.379,P<0.05),and positively correlated with PI and RI levels(r=0.316,0.323,P<0.05).Middle cerebral artery PI and RI levels were negatively correlated with MoCA scale scores of cognitive dysfunction during rehabilitation,while BHI levels were positively correlated with MoCA scale scores(r=-0.324,-0.406,0.383,P<0.05).ROC curve analysis showed that the AUC for predicting the prognosis of patients with PI,RI and BHI was 0.803,which was higher than the AUC evaluated by the 3 indexes alone(P<0.05).Conclusion:Vm and BHI levels of IS patients in the convalescence stage are higher than those in the acute stage,while PI and RI levels are lower than those in the acute stage.The levels of PI,RI and BHI in the acute stage can predict and evaluate the prognosis of patients to a certain extent.High PI,RI,and low BHI levels during the rehabilitation phase are associated with cognitive dysfunction and poor prognosis.