经颅多普勒超声对椎—基底动脉狭窄或闭塞的诊断价值

发布时间：2019-02-27 19:38

【摘要】：目的：以磁共振血管成像（MRA）为诊断颅内血管狭窄的确证方法，探讨经颅多普勒超声（TCD）评估椎动脉（Vertebral artery，VA）和基底动脉（Basilar artery，BA）狭窄临床诊断中的应用价值。方法：2013年7月至2014年10月在吉林大学白求恩第一医院住院、经TCD检查提示椎-基底动脉血流异常的缺血性脑血管病患者221例并于1周内行MRA检查的患者，比较两种方法对椎-基底动脉的检测结果。依据MRA结果分为正常组与狭窄组，TCD检测记录各组中椎-基底动脉的收缩期峰值流速（Peak Systolic Velocity，PSV)、舒张期流速（End Diastolic Velocity，EDV）、平均流速（Mean Flow Velaocity，MFV）、动脉搏动指数（PI）、频谱形态及声频特征等，并对两组检测结果进行对比分析。应用Kappa值度量TCD和MRA这两种检查方法的一致性。结果：共有221例患者，男性187例（84.62%），女性34例（15.38%），年龄33～88岁（平均为60.02±10.98岁）患者纳入研究对象。221例患者共检测椎-基底动脉655条，其中左侧椎动脉218条（33.28%），，右侧椎动脉216条（32.98%），椎动脉共434条（66.26%），基底动脉221条（33.74%），其中8例为单侧椎动脉。TCD检查提示正常血管350条（53.44%），狭窄血管为305条（46.56%）。MRA检查提示正常血管324条（49.47%），其中基底动脉118条，左侧椎动脉108条，右侧椎动脉98条；狭窄血管为331条（50.53%），其中基底动脉103条，左侧椎动脉110条，右侧椎动脉118条。以MRA检测结果为参照，显示TCD诊断椎动脉狭窄或闭塞的敏感性、特异性、假阳性率、假阴性率分别为78.95%、83.98%、16.02%、21.05%，符合率81.34%、Kappa值0.6226；TCD诊断基底动脉狭窄或闭塞的敏感性、特异性、假阳性率、假阴性率分别为79.61%、91.53%、8.47%、20.39%，符合率85.97%、Kappa值0.7162(95%置信下限0.6241，95%置信上限0.8083)。TCD诊断椎-基底动脉总体狭窄或闭塞的敏感性、特异性、假阳性率、假阴性率分别为79.15%、86.73%、13.27%、20.85%，符合率82.90%、Kappa值0.6583(95%置信下限0.6008，95%置信上限0.7157)。结论：TCD对椎-基底动脉狭窄或闭塞的诊断具有较高的特异性和敏感性，且特异性高于敏感性。TCD可较准确地判断椎-基底动脉有无狭窄，且TCD与MRA有很好的一致性。TCD检测方法结果可靠，是临床作为初步筛查椎-基底动脉狭窄的首选方法。
[Abstract]:Aim: to evaluate the diagnostic value of transcranial Doppler (TCD) (TCD) in the diagnosis of vertebral artery (Vertebral artery,VA) and basilar artery (Basilar artery,BA) stenosis using magnetic resonance angiography (MRA) as a definite diagnosis method. Methods: from July 2013 to October 2014 in Bethune first Hospital of Jilin University, 221 patients with ischemic cerebrovascular disease with abnormal vertebrobasilar blood flow were examined by TCD and MRA was performed within one week. The results of vertebrobasilar artery detection by two methods were compared. According to the results of MRA, they were divided into normal group and stenosis group. The peak systolic velocity (Peak Systolic Velocity,PSV), diastolic velocity (End Diastolic Velocity,EDV) and mean velocity (Mean Flow Velaocity,MFV) of vertebrobasilar artery in each group were recorded by TCD. Arterial pulsatility index (PI),) spectrum morphology and sound frequency characteristics were compared and analyzed between the two groups. Kappa value is used to measure the consistency between TCD and MRA. Results: 221 patients, 187 males (84.62%) and 34 females (15.38%), aged 33 to 88 years (average 60.02 卤10.98 years) were enrolled in the study. 655 vertebrobasilar arteries were detected in 221 patients. There were 218 left vertebral arteries (33.28%), 216 right vertebral arteries (32.98%), 434 vertebral arteries (66.26%) and 221 basilar arteries (33.74%). TCD showed 350 normal vessels (53.44%), 305 stenotic vessels (46.56%), 324 normal arteries (49.47%), 118 basilar arteries. There were 108 left vertebral arteries and 98 right vertebral arteries. The number of stenosis vessels was 331 (50.53%), of which 103 were basilar artery, 110 were left vertebral artery and 118 were right vertebral artery. The sensitivity, specificity, false positive rate and false negative rate of TCD in the diagnosis of vertebral artery stenosis or occlusion were 78.95%, 83.98%, 16.02%, 21.05%, respectively, and the coincidence rate was 81.34%. Kappa value 0.6226; The sensitivity, specificity, false positive rate and false negative rate of TCD in the diagnosis of basilar artery stenosis or occlusion were 79.61%, 91.53%, 8.47%, 20.39%, respectively, and the coincidence rate was 85.97%. The sensitivity, specificity, false positive rate and false negative rate of Kappa in the diagnosis of vertebrobasilar artery stenosis or occlusion were 79.15%, 86.73%, 13.27%, respectively, and the sensitivity, specificity, false positive rate and false negative rate were 79.15%, 86.73%, 13.27%, respectively. The Kappa value was 0.6583 (95% confidence lower limit 0.6008, 95% confidence upper limit 0.7157). Conclusion: TCD has high specificity and sensitivity in the diagnosis of vertebrobasilar artery stenosis or occlusion, and the specificity is higher than that of sensitivity. The results of TCD were reliable and it was the first choice for screening vertebrobasilar artery stenosis.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3

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