超声检测大脑中动脉慢性闭塞患者脑血流与脑梗死的相关性

发布时间：2018-03-10 04:09

本文选题：大脑中动脉闭塞　切入点：经颅多普勒超声　出处：《中国脑血管病杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的探讨大脑中动脉慢性闭塞(CMCAO)患者大脑前动脉(ACA)脑膜支代偿(LMA)对脑梗死大小的影响,分析大脑中动脉(MCA)流速与脑梗死面积的相关性。方法回顾性连续纳入2014年6月至2016年6月延边大学附属医院神经内科35例和首都医科大学宣武医院神经内科的CMCAO患者74例,对所有患者采用经颅多普勒超声(TCD)和(或)经颅彩色多普勒超声(TCCS)诊断为一侧CMCAO而对侧MCA正常,并经DSA证实。根据DSA显示ACA有无脑膜支,分为LMA组49例及无LMA组(NLMA)60例。采用TCCS和(或)TCD测量,记录患侧与健侧MCA的收缩期峰值流速(PSV)及平均流速(MFV),并计算健侧、患侧PSV比值(PSV_(健侧)/PSV_(患侧))。根据磁共振扩散加权成像(DWI)检查结果分为脑组织正常、腔隙性脑梗死、中小面积脑梗死及大面积脑梗死4级,采用秩和检验比较LMA组与NLMA组脑梗死面积的差异,并采用Spearman秩相关分析患侧MCA的血流参数与脑梗死面积的相关性。结果 (1)两组患者的患侧与健侧MCA的PSV、MFV及PSV_(健侧)/PSV_(患侧)差异均无统计学意义(均P0.05)。(2)NLMA组中卒中者占90.0%(54例),明显高于LAM组71.4%(35例),两组间差异有统计学意义(P0.05);LMA组DWI以腔隙性脑梗死为主(51.0%,25例),NLMA组多以中小面积脑梗死为主(45.0%,27例),并且大面积脑梗死发生率(21.7%,13例)高于LMA组(4.1%,2例),两组差异有统计学意义(P0.01)。(3)NLMA组患者脑梗死面积与MCA的PSV呈中度负相关(r=-0.736,P0.01),并随PSV_(健侧)/PSV_(患侧)的升高而增加,呈高度正相关(r=0.849,P0.01)。结论 CMCAO患者ACA的LMA状态与脑梗死严重程度相关,患侧MCA血流速度的减低与脑梗死面积存在明显相关性。
[Abstract]:Objective to investigate the effect of meningeal collateral compensation (LMA) on the size of cerebral infarction in patients with chronic middle cerebral artery occlusion (CMCAO). Methods 35 cases of neurology department of Yanbian University affiliated Hospital from June 2014 to June 2016 and 74 cases of CMCAO patients in Department of Neurology of Xuanwu Hospital of Capital Medical University were included retrospectively. All patients were diagnosed by transcranial Doppler ultrasonography (TCD) and / or transcranial color Doppler ultrasound (TCCS) as unilateral CMCAO and contralateral MCA was normal, and confirmed by DSA. According to DSA, there were meningeal branches in ACA. LMA group (n = 49) and no LMA group (n = 60) were divided into two groups. The peak systolic velocities and mean flow velocity of MCA were measured by TCCS and / or TCD, and the normal side was calculated. According to the results of diffusion-weighted Mr imaging (DWI), the patients were divided into 4 grades: normal brain tissue, lacunar cerebral infarction, middle and small area cerebral infarction and large area cerebral infarction. The difference of cerebral infarction area between LMA group and NLMA group was compared by rank sum test. Spearman rank correlation analysis was used to analyze the correlation between the blood flow parameters of the affected side MCA and the area of cerebral infarction. Results 1) there was no significant difference between the two groups in the MCA of the affected side and the healthy side. There were 54 cases of cerebral infarction in 90.0%, which was significantly higher than that in LAM group (71.4%, 35 cases). The difference between the two groups was statistically significant. The DWI of the two groups was mainly 51.0% of lacunar cerebral infarction, and 27 cases were mainly small and medium area cerebral infarction, and the incidence of large area cerebral infarction was 21.713 cases). There were significant differences between the cerebral infarct area and the PSV of MCA in the LMA group (P 0.01). The cerebral infarct size was negatively correlated with the PSV of MCA, and increased with the increase of PSV / P / P 0. 01, and increased with the increase of PSV / P / P 0. 01%, and increased with the increase of PSV / P / P 0. 01% P < 0. 01%, and increased with the increase of PSV / P / P 0. 01% (P < 0. 01). Conclusion the LMA status of ACA in patients with CMCAO is correlated with the severity of cerebral infarction, and the decrease of the blood flow velocity of MCA in the affected side is significantly correlated with the area of cerebral infarction.
【作者单位】：延边大学附属医院超声科;首都医科大学宣武医院血管超声科;
【分类号】：R445.1;R743.3

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