中国脑血管病杂志
中國腦血管病雜誌
중국뇌혈관병잡지
CHINESE JOURNAL OF CEREBROVASCULAR DISEASES
2014年
9期
454-460
,共7页
李燕%王力力%赵新宇%夏明钰%段春%高明杰%华扬
李燕%王力力%趙新宇%夏明鈺%段春%高明傑%華颺
리연%왕력력%조신우%하명옥%단춘%고명걸%화양
超声检查,多普勒,经颅%卒中%危险因素%大脑中动脉%狭窄,重度%短暂性脑缺血发作
超聲檢查,多普勒,經顱%卒中%危險因素%大腦中動脈%狹窄,重度%短暫性腦缺血髮作
초성검사,다보륵,경로%졸중%위험인소%대뇌중동맥%협착,중도%단잠성뇌결혈발작
Ultrasonography,Doppler,transcranial%Stroke%Riskfactors%Middlecerebralartery%Stenosis,severe%Transient ischemic attack
目的：通过经颅多普勒超声（TCD）动态观察单侧大脑中动脉（MCA）重度狭窄患者的血流动力学参数变化，对影响狭窄进程的相关因素进行分析。方法回顾性连续纳入经TCD筛查并经CT血管成像（CTA）或DSA证实单侧MCA重度狭窄的患者133例，根据MCA血流动力学参数变化，分为进展组43例和非进展组90例，并记录分析患者年龄、性别、脑血管病主要危险因素、临床症状、临床用药及药物依从性对狭窄进程的影响。结果（1）脑血管病危险因素检出率比较：进展组有吸烟史的患者[72.1％（31例）]明显高于非进展组[51.1％（46例），P＝0.022]；进展组患者吸烟时间长于非进展组[（28±12）年比（21±10）年，P＝0.011]。（2）MCA血流动力学参数比较：首诊时MCA狭窄远段搏动指数进展组低于非进展组（0.66±0.10比0.70±0.13，t ＝-2．096，P＝0.038），结点时MCA狭窄远段搏动指数进展组中狭窄程度进展患者低于非进展组患者（0.61±0.15比0.74±0.15），差异有统计学意义（t＝-2.718，P＝0.008）。结点时，进展组中10例狭窄程度进展患者MCA狭窄段收缩期峰值流速高于非进展组[（299±23）cm/s比（244±50）cm/s，t ＝3.437，P＝0.001]，而33例闭塞患者的MCA收缩期峰值流速明显低于非进展组[（56±18）cm/s比（244±50）cm/s，t＝-20.905，P＝0.000]。（3）规律性用药：规律性服用他汀类药物（阿托伐他汀）的患者进展组明显低于非进展组[2.3％（1例）比54.4％（49例），χ2＝33.690，P＜0.01]。（4）随访期间短暂性脑缺血发作和卒中再发率进展组明显高于非进展组[27.9％（12例）比6.7％（6例），32.6％（14例）比2.2％（2例）；均P＜0.01]。（5）多元 Logistic回归分析，吸烟者（OR ＝4.403，95％CI：1.094～14.017）、脑血管事件再发（OR＝10.648，95％CI：2.530～41.261）及非规律性服用他汀类药（OR＝5.675，95％CI：1.631～152.740）均与 MCA重度狭窄程度的进展密切相关。结论 TCD随访评价MCA重度狭窄的血流动力学变化，可以作为临床评估转归的重要依据。戒烟及规律性服用他汀类药物治疗有助于延缓MCA狭窄程度的进展。
目的：通過經顱多普勒超聲（TCD）動態觀察單側大腦中動脈（MCA）重度狹窄患者的血流動力學參數變化，對影響狹窄進程的相關因素進行分析。方法迴顧性連續納入經TCD篩查併經CT血管成像（CTA）或DSA證實單側MCA重度狹窄的患者133例，根據MCA血流動力學參數變化，分為進展組43例和非進展組90例，併記錄分析患者年齡、性彆、腦血管病主要危險因素、臨床癥狀、臨床用藥及藥物依從性對狹窄進程的影響。結果（1）腦血管病危險因素檢齣率比較：進展組有吸煙史的患者[72.1％（31例）]明顯高于非進展組[51.1％（46例），P＝0.022]；進展組患者吸煙時間長于非進展組[（28±12）年比（21±10）年，P＝0.011]。（2）MCA血流動力學參數比較：首診時MCA狹窄遠段搏動指數進展組低于非進展組（0.66±0.10比0.70±0.13，t ＝-2．096，P＝0.038），結點時MCA狹窄遠段搏動指數進展組中狹窄程度進展患者低于非進展組患者（0.61±0.15比0.74±0.15），差異有統計學意義（t＝-2.718，P＝0.008）。結點時，進展組中10例狹窄程度進展患者MCA狹窄段收縮期峰值流速高于非進展組[（299±23）cm/s比（244±50）cm/s，t ＝3.437，P＝0.001]，而33例閉塞患者的MCA收縮期峰值流速明顯低于非進展組[（56±18）cm/s比（244±50）cm/s，t＝-20.905，P＝0.000]。（3）規律性用藥：規律性服用他汀類藥物（阿託伐他汀）的患者進展組明顯低于非進展組[2.3％（1例）比54.4％（49例），χ2＝33.690，P＜0.01]。（4）隨訪期間短暫性腦缺血髮作和卒中再髮率進展組明顯高于非進展組[27.9％（12例）比6.7％（6例），32.6％（14例）比2.2％（2例）；均P＜0.01]。（5）多元 Logistic迴歸分析，吸煙者（OR ＝4.403，95％CI：1.094～14.017）、腦血管事件再髮（OR＝10.648，95％CI：2.530～41.261）及非規律性服用他汀類藥（OR＝5.675，95％CI：1.631～152.740）均與 MCA重度狹窄程度的進展密切相關。結論 TCD隨訪評價MCA重度狹窄的血流動力學變化，可以作為臨床評估轉歸的重要依據。戒煙及規律性服用他汀類藥物治療有助于延緩MCA狹窄程度的進展。
목적：통과경로다보륵초성（TCD）동태관찰단측대뇌중동맥（MCA）중도협착환자적혈류동역학삼수변화，대영향협착진정적상관인소진행분석。방법회고성련속납입경TCD사사병경CT혈관성상（CTA）혹DSA증실단측MCA중도협착적환자133례，근거MCA혈류동역학삼수변화，분위진전조43례화비진전조90례，병기록분석환자년령、성별、뇌혈관병주요위험인소、림상증상、림상용약급약물의종성대협착진정적영향。결과（1）뇌혈관병위험인소검출솔비교：진전조유흡연사적환자[72.1％（31례）]명현고우비진전조[51.1％（46례），P＝0.022]；진전조환자흡연시간장우비진전조[（28±12）년비（21±10）년，P＝0.011]。（2）MCA혈류동역학삼수비교：수진시MCA협착원단박동지수진전조저우비진전조（0.66±0.10비0.70±0.13，t ＝-2．096，P＝0.038），결점시MCA협착원단박동지수진전조중협착정도진전환자저우비진전조환자（0.61±0.15비0.74±0.15），차이유통계학의의（t＝-2.718，P＝0.008）。결점시，진전조중10례협착정도진전환자MCA협착단수축기봉치류속고우비진전조[（299±23）cm/s비（244±50）cm/s，t ＝3.437，P＝0.001]，이33례폐새환자적MCA수축기봉치류속명현저우비진전조[（56±18）cm/s비（244±50）cm/s，t＝-20.905，P＝0.000]。（3）규률성용약：규률성복용타정류약물（아탁벌타정）적환자진전조명현저우비진전조[2.3％（1례）비54.4％（49례），χ2＝33.690，P＜0.01]。（4）수방기간단잠성뇌결혈발작화졸중재발솔진전조명현고우비진전조[27.9％（12례）비6.7％（6례），32.6％（14례）비2.2％（2례）；균P＜0.01]。（5）다원 Logistic회귀분석，흡연자（OR ＝4.403，95％CI：1.094～14.017）、뇌혈관사건재발（OR＝10.648，95％CI：2.530～41.261）급비규률성복용타정류약（OR＝5.675，95％CI：1.631～152.740）균여 MCA중도협착정도적진전밀절상관。결론 TCD수방평개MCA중도협착적혈류동역학변화，가이작위림상평고전귀적중요의거。계연급규률성복용타정류약물치료유조우연완MCA협착정도적진전。
Objectives Todynamicallyobservethechangesofhemodynamicparametersinpatients with severe stenosis of unilateral middle cerebral artery (MCA)by transcranial Doppler ultrasound (TCD) andtoevaluateandanalyzetherelatedfactorsforinfluencingthestenoticprocess.Methods Atotalof 113 consecutive patients with severe stenosis of unilateral MCA screened by TCD and confirmed by computed tomography angiography (CTA)and digital subtraction angiography (DSA)were enrolled retrospectively. They were divided into either a progressive group (n =43 )or a non-progressive group (n=90)according to the variation of MCA hemodynamic parameters. The effects of age,sex,major risk factors for cerebrovascular disease,clinical symptoms,clinical medication,and drug compliance on the stenotic process were documented and analyzed. Results (1)The comparison of detection rate of the risk factors for cerebrovascular disease:The patients with a history of smoking (72. 1%[n=31])in the progressive group was significantly higher than that (51. 1%[n=46])in the non-progressive group (P=0.022). The period of smoking of the patients in the progressive group were longer than that in the non-progressive group (28 ± 12 years vs. 21 ± 10 years,P=0. 011). (2)Comparison of MCA hemodynamic parameters:The distal pulsatility indexes of MCA stenosis at the first diagnosis in the progressive group were all lower than those in the non-progressive group (0. 66 ± 0. 10 vs. 0. 70 ± 0. 13;t= -2. 096,P=0. 038),and the distal pulsatility indexes of MCA stenosis at the end point in the patients of the progressive group were lower than those in the non-progressive group (0. 61 ± 0. 15 vs. 0. 74 ± 0. 15). There were significant differences (t=-2. 718,P= 0. 008). The peak systolic velocity (PSV)of the progressive MCA stenotic segments at the end point in 10 patients of the progressive group was higher than that in the non-progressive group (299 ± 23 cm/s vs. 244 ± 50 cm/s,t=3. 437;P=0. 001),while PSV of MCA in 33 patients with occlusion in the progressive group were significantly lower than those in the non-progressive group (56 ± 18 cm/s vs. 244 ± 50 cm/s,t= -20. 905;P=0. 000). (3)The regular medication:The patients using statins (atorvastatin calcium)were significantly lower than those of the non-progressive group (2. 3%[n=1] vs. 54. 4%[n=49],χ2 =33. 690;P<0. 01). (4)During the follow up period,the recurrence rates of transient ischemic attack and stroke of the progressive group were significantly higher than those of the non-progressive group (27. 9%[n=12]vs. 6. 7%[n=6],32. 6%[n=14]vs. 2. 2%[n=2];all P<0.01). (5)Multivariate Logistic regression analysis showed that smokers (OR,4. 403,95%CI 1. 094-14.017),cerebrovascular event recurrence (OR,10. 648,95%CI 2. 530 -41. 261),and irregularly taking statins (OR,5. 675,95%CI 1. 631-152. 740)were all closely associated with the progress of severeMCAstenosis.Conclusion EvaluationofthehemodynamicchangesofsevereMCAstenosiswith TCD follow up study can be used as an important basis for clinical assessment of the outcomes. Stop smoking and regularly taking statins may help to delay the progress of MCA stenosis.
