椎动脉狭窄与后循环脑血管反应性的相关性研究

发布时间：2018-05-06 14:19

本文选题：脑血管反应性 + 后循环梗死　；参考：《南京大学》2014年硕士论文

【摘要】：第一部分颅内外大动脉无狭窄患者发生后循环梗死的血管反应性评估研究目的：通过对颅内外大动脉无明显狭窄但发生后循环梗死的患者大脑中动脉血管反应性(cerebrovascular reactivity in middle cerebral artery, MCVR)和椎动脉血管反应性(cerebrovascular reactivity in vertebral artery, VCVR)的比较,探讨CVR改变在预测后循环梗死中的作用。方法：选择后循环梗死患者27例(PCI组),选择同期健康体检者25例(对照组)。采用经颅多普勒超声(transcranial doppler sonography, TCD)结合CO2吸入试验检测所有入选者的MCVR和VCVR。结果：与对照组比较,PCI组双侧MCVR明显下降(左侧：25.96±15.90% vs 34.63±8.60%,右侧：26.40±14.54% vs 34.49±9.08%,P0.05)；而双侧VCVR较对照组虽也有所下降,但差异无统计学意义(P0.05)。多变量线性回归分析显示,糖尿病是MCVR受损的独立危险因素(p=-0.116,P=0.035)。结论：对于颅内外大动脉无明显狭窄的PCI患者,MCVR显著下降,VCVR受损则不明显,MCVR或可作为脑大动脉无明显狭窄者后循环梗死的预测指标。对于颅内外大动脉无明显狭窄的PCI患者,糖尿病是MCVR降低的独立危险因素。第二部分椎动脉狭窄程度与脑血管反应性的相关性研究研究目的：CVR是评估脑血管储备能力的主要指标。以往关于MCVR与颈内动脉(internal carotid artery, ICA)或大脑中动脉(middle cerebral artery, MCA)狭窄程度之间关系的研究较多,而针对VCVR与椎动脉(vertebral artery, VA)狭窄程度相关性的研究少见。本研究采用TCD结合C02吸入试验探讨VCVR与椎动脉狭窄之间的关系。方法：选择2012年4月-2013年5月间在南京军区南京总医院神经内科住院治疗、经DSA证实一侧VA狭窄而ICA和MCA无明显狭窄的PCI患者30例；同期的住院病人中无颅内外大血管狭窄的24例PCI患者作为对照组。利用TCD结合C02吸入试验检测所有入选患者的VCVR和MCVR。结果：VA狭窄侧的VCVR较狭窄对侧的明显下降,差异有统计学意义(28.82±12.91% vs31.52±14.09%,P0.05),而VA狭窄同侧和对侧的MCVR无显著统计学差异(27.07±15.77% vs 29.12±17.16%, P 0.05). VCVR下降程度与VA狭窄程度存在显著相关性(correlation coefficient=-0.470, P 0.01).多重线性回归分析显示VA狭窄和糖尿病是VCVR下降的独立危险因素(β=-0.432,P=0.009,p=-0.405,P=0.013)。结论：MCVR与VA狭窄之间无明显相关,而VCVR与VA狭窄程度有较好的负相关关系,提示前后循环间尽管存在Willis环,其血流储备仍相对独立,在临床及科研工作中应充分考虑前后循环CVR的相对独立性。第三部分椎动脉支架置入对后循环脑血管反应性的影响研究目的：椎动脉支架置入术(vertebral artery stenting,VAS)已成为VA重度狭窄的重要治疗手段,但无论是手术适应症的选择还是术后疗效的评估,目前仅局限于影像学狭窄程度和临床症状的评估,缺乏手术前后后循环区域脑血流动力学变化的研究,本文探讨VAS对VCVR的影响。方法：24例接受VAS治疗的症状性VA狭窄患者作为手术组,同期住院的22例无VA狭窄或狭窄率50%的PCI患者作为对照组。采用TCD结合CO2吸入试验观察VAS前后的VCVR的变化。结果：手术组患者术前VA狭窄侧和对侧的VCVR与对照组相比均明显下降(25.37±9.42%vs 31.51±10.59%,28.84±7.07% vs 35.98±15.48%,P0.05)；手术组患者术前VA狭窄侧VCVR较对侧亦明显下降(25.37±9.42%vs 28.84±7.07%,P0.05)。VAS术后,虽然术侧和对侧VCVR均有所改善,但与术前相比无显著统计学差异。结论：VAS是目前治疗VA狭窄的重要手段,但术后短期内后循环脑血流动力学并无明显改善,VAS对后循环脑血流动力学的远期影响有待于进一步的随访研究。
[Abstract]:Part 1 vascular reactivity assessment of posterior circulatory infarction in patients with intracranial and extracranial artery stenosis Objective: cerebrovascular reactivity in middle cerebral artery, MCVR, and vertebral artery vascular reactivity (c) in patients with no significant stenosis but posterior circulation infarction (c). The comparison of erebrovascular reactivity in vertebral artery, VCVR) to explore the role of CVR changes in the prediction of posterior circulation infarction. Methods: 27 patients with posterior circulation infarction (group PCI) were selected and 25 patients (control group) were selected at the same period of health examination. MCVR and VCVR. results of all the participants were measured: compared with the control group, the bilateral MCVR decreased significantly in the PCI group (left: 25.96 + 15.90% vs 34.63 + 8.60%, 26.40 + 14.54% vs 34.49 + 9.08%, P0.05), while bilateral VCVR was also lower than the control group, but the difference was not statistically significant (P0.05). It is an independent risk factor for MCVR damage (p=-0.116, P=0.035). Conclusion: for PCI patients with no obvious stenosis in the intracranial and external large arteries, MCVR is significantly decreased, VCVR is not impaired, MCVR or can be used as a predictor of posterior circulation infarction in patients with no obvious stenosis of the large cerebral arteries. For PCI patients with no obvious stenosis of the intracranial large artery, the diabetes is MCVR An independent risk factor for reduction. A study of correlation between the degree of vertebral artery stenosis and cerebrovascular reactivity in part second: Objective: CVR is the main index to evaluate the ability of cerebral vascular reserve. The relationship between MCVR and the stenosis degree of the internal carotid artery (internal carotid artery, ICA) or the middle cerebral artery (middle cerebral artery, MCA) There are more studies on the correlation between VCVR and the degree of vertebral artery (VA) stenosis. This study uses TCD combined with C02 inhalation to explore the relationship between VCVR and vertebral artery stenosis. Methods: in April 2012 -2013 year and May in the Department of Neurology in the General Hospital of Nanjing Military District, Nanjing general hospital, and DSA confirmed one side VA narrowness. 30 patients with narrow ICA and MCA without obvious stenosis; 24 cases of PCI patients without intracranial and internal large vascular stenosis in the same period of hospitalized patients were used as the control group. The VCVR and MCVR. results of all selected patients were detected by TCD combined with C02 inhalation test: the VA narrow side VCVR was significantly lower than that of the narrow side, the difference was statistically significant (28.82 + 12.91%). Vs31.52 + 14.09%, P0.05), but there was no significant statistical difference between VA stenosis at the ipsilateral and contralateral MCVR (27.07 + 15.77% vs 29.12 + 17.16%, P 0.05). The degree of VCVR decline was significantly correlated with the degree of VA stenosis (correlation coefficient=-0.470, P 0.01). Multiple linear regression analysis showed that VA stenosis and diabetes were independent risk factors Conclusion: (beta =-0.432, P=0.009, p=-0.405, P=0.013). Conclusion: there is no obvious correlation between MCVR and VA stenosis, and there is a better negative correlation between VCVR and VA stenosis. The blood flow reserve is still relatively independent, and the relative independence of the circulation CVR should be fully considered in clinical and scientific research. Third parts should be fully considered in clinical and scientific research. The effect of the stent placement on the reactivity of the cerebrovascular reactivity of the posterior circulation: vertebral artery stenting (VAS) has become an important treatment for severe VA stenosis. However, the selection of surgical indications and the evaluation of postoperative curative effect are limited to the degree of imaging stenosis and clinical symptoms. The study of cerebral hemodynamic changes in the posterior circulation region before and after operation was evaluated. The effect of VAS on VCVR was investigated. Methods: 24 patients with symptomatic VA stenosis treated with VAS were used as the operation group, and 22 cases of PCI patients who were hospitalized without VA stenosis or stenosis rate 50% were used as control group. TCD combined with CO2 inhalation test was used to observe before and after VAS. Results: the VA stenosis and the contralateral VCVR in the operation group were significantly lower than those in the control group (25.37 + 9.42%vs 31.51 + 10.59%, 28.84 + 7.07% vs 35.98 + 15.48%, P0.05). The VA narrowed side of the operation group was significantly lower than the contralateral side (25.37 + 9.42%vs 28.84 + VA, P0.05).VAS after operation, although the operation side and the right side were on the side. There is no significant difference in side VCVR, but there is no significant difference compared with preoperative. Conclusion: VAS is an important means for the treatment of VA stenosis, but the short term and posterior circulation cerebral hemodynamics after operation is not obviously improved. The long-term effect of VAS on the cerebral hemodynamics of the posterior circulation remains to be further followed up.

【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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