TCD监测颅内血流动力学变化与脑小血管病患者病情严重程度及神经功能恶化的相关性

The correlation of intracranial hemodynamic changes monitored by TCD with the severity and neurological deterioration in patients with cerebral small vascular disease

目的探讨经颅多普勒超声(TCD)监测颅内血流动力学变化与脑小血管病(CSVD)患者病情严重程度及神经功能恶化的相关性,为早期制定治疗方案、改善CSVD预后提供参考依据。方法回顾性分析2022-01—2023-12在郑州大学第二附属医院住院的98例CSVD患者的临床资料,采用磁共振成像(MRI)评估CSVD患者的MRI总负荷,采用经颅多普勒(TCD)监测大脑中动脉(MCA)和大脑前动脉(ACA)双侧血流动力学参数血流速度(Vm)、搏动指数(PI),比较轻中度负荷组和重度负荷组MCA和ACA的Vm、PI值,分析MCA和ACA的Vm、PI值与CSVD患者MRI负荷严重程度的相关性。根据CSVD患者入院1周内是否发生神经功能恶化分为恶化组和未恶化组,比较2组患者MCA和ACA的Vm、PI值,分析MCA和ACA的Vm、PI值与CSVD患者发生神经功能恶化的相关性。结果重度负荷组患者入院时MCA和ACA的Vm(41.35±5.47、35.44±3.37)均低于轻中度负荷组(48.32±6.43、44.61±4.86),而重度负荷组MCA和ACA的PI(1.17±0.26、0.98±0.23)均高于轻中度负荷组(0.92±0.21、0.78±0.19),组间比较差异均有统计学意义(P<0.05);MCA和ACA的Vm与MRI负荷严重程度呈负相关,而PI与MRI负荷严重程度呈正相关(均P<0.05);恶化组入院时MCA和ACA的Vm(39.38±4.37、34.11±2.34)均低于未恶化组(48.34±6.07、44.11±4.82),而恶化组MCA和ACA的PI(1.25±0.22、1.06±0.16)均高于未恶化组(0.91±0.19、0.76±0.19),组间比较差异有统计学意义(P<0.05);MCA和ACA的Vm与CSVD患者神经功能恶化的发生呈负相关,而PI与CSVD患者神经功能恶化的发生呈正相关(均P<0.05)。结论颅内血流动力学参数异常与CSVD患者病情严重程度和神经功能恶的发生均具有相关性,通过TCD监测CSVD患者的颅内血流动力学参数,可早期评估CSVD患者的严重程度,早期发现神经功能恶化的风险。

Objective To investigate the correlation of intracranial hemodynamic changes monitored by transcranial Doppler ultrasound(TCD)with the severity and neurological deterioration in patients with cerebral small vascular disease(CSVD),so as to provide reference for early treatment and improvement of prognosis of CSVD.Methods A total of 98 CSVD patients hospitalized in the Second Affiliated Hospital of Zhengzhou Universit from January 2022 to December 2023 were retrospectively included.MRI was used to evaluate the total MRI load of CSVD patients,and bilateral hemodynamic parameters of the middle cerebral artery(MCA)and anterior cerebral artery(ACA)were monitored by TCD.Mean velocity(Vm)and pulsitility index(PI)of MCA and ACA were compared between the mild to moderate load group and the severe load group.The correlation of the Vm and PI of MCA and ACA with the severity of MRI load in CSVD patients was analyzed.Patients with CSVD were divided into worsening group and the non-worsening group according to whether neurological function deteriorated within 1 week of admission.Vm and PI of MCA and ACA were compared between the worsening group and the non-worsening group,and the correlation of Vm and PI of MCA and ACA with neurological function deterioration in CSVD patients was analyzed.Results Vm of MCA and ACA in CSVD severe load group(41.35±5.47,35.44±3.37)was lower than that in mild to moderate load group(48.32±6.43,44.61±4.86),PI of MCA and ACA in CSVD severe load group(1.17±0.26,0.98±0.23)was higher than that in mild to moderate load group(0.92±0.21,0.78±0.19)(P<0.05).Vm of MCA and ACA was negatively correlated with the severity of MRI load,while PI was positively correlated with the severity of MRI load(P<0.05).The Vm of MCA and ACA in the worsening group(39.38±4.37,34.11±2.34)was lower than that in the non-worsening group(48.34±6.07,44.11±4.82),and the PI of MCA and ACA in the worsening group(1.25±0.22,1.06±0.16)was higher than that in the non-worsening group(0.91±0.19,0.76±0.19)(P<0.05).Vm in MCA and ACA was negatively correlated with neurological deterioration in CSVD patients,while PI was positively correlated with neurological deterioration in CSVD patients(P<0.05).Conclusion Abnormal intracranial hemodynamic parameters are correlated with the severity of CSVD patients and the occurrence of neurological dysfunction.Monitoring intracranial hemodynamic parameters of CSVD patients by TCD may early assess the severity and risk of neurological deterioration in CSVD patients.