CAJ | 학술논문

目的：观察经颅多普勒（transcranial doppler ，TCD）检测大脑中动脉狭窄或闭塞的可靠性，分析 TCD在急性脑梗死（ACI）中的临床应用价值，以期探讨大脑中动脉（middle cerebral artery ，MCA）狭窄或闭塞导致脑梗死的类型及其可能的发病机制。方法选取确诊为 MCA 区 ACI患者122例，分别行 TCD、头部磁共振血管成像（magnetic resonance angiography ， MRA）及磁共振成像（Magnetic Resonance Imaging ，MRI）检查，比较TCD与MRA检测MCA的结果。根据MRI将122例患者分为大面积CI组、小面积梗死组及腔隙性CI组，比较不同面积脑梗死（cerebral infarction ，CI）患者MCA异常情况有无差异。结果 TCD诊断MCA狭窄或闭塞的敏感性为80.0％，特异性是82.8％，与MRA的符合率是81.8％；TCD检测不同面积CI患者的MCA异常情况无显著性差别；122例MCA区梗死患者和34例MCA狭窄性患者的梗死类型中，分水岭梗死和腔隙性梗死为最常见类型。结论① TCD检测MCA狭窄或闭塞的敏感性和特异性较高，与MRA的相符性较好；② MCA狭窄性梗死多引起腔隙性、分水岭区或深穿支供血区梗死，较少引起MCA供血区完全性梗死。③动脉－动脉栓塞与血流低灌注可能是MCA狭窄性梗死的重要发病机制。
목적：관찰경로다보륵（transcranial doppler ，TCD）검측대뇌중동맥협착혹폐새적가고성，분석 TCD재급성뇌경사（ACI）중적림상응용개치，이기탐토대뇌중동맥（middle cerebral artery ，MCA）협착혹폐새도치뇌경사적류형급기가능적발병궤제。방법선취학진위 MCA 구 ACI환자122례，분별행 TCD、두부자공진혈관성상（magnetic resonance angiography ， MRA）급자공진성상（Magnetic Resonance Imaging ，MRI）검사，비교TCD여MRA검측MCA적결과。근거MRI장122례환자분위대면적CI조、소면적경사조급강극성CI조，비교불동면적뇌경사（cerebral infarction ，CI）환자MCA이상정황유무차이。결과 TCD진단MCA협착혹폐새적민감성위80.0％，특이성시82.8％，여MRA적부합솔시81.8％；TCD검측불동면적CI환자적MCA이상정황무현저성차별；122례MCA구경사환자화34례MCA협착성환자적경사류형중，분수령경사화강극성경사위최상견류형。결론① TCD검측MCA협착혹폐새적민감성화특이성교고，여MRA적상부성교호；② MCA협착성경사다인기강극성、분수령구혹심천지공혈구경사，교소인기MCA공혈구완전성경사。③동맥－동맥전새여혈류저관주가능시MCA협착성경사적중요발병궤제。
Objective To observe the reliability of transcranial doppler (TCD) in the diagnosis of Middle Cerebral Artery (MCA) stenosis and occlusive .To analyze the clinical employing value of TCD in acute cerebral infarction (ACI) .To investigate the type and pathogenesy of ACI caused by MCA stenosis or occlusive .Methods TCD and Magnetic Resonance Angiography (MRA) were performed in 122 inpatients with ACI to compare the results of TCD and MRA detecting on MCA .Results The sensitivity ,specificity ,coincidence of TCD were 80.0% ,82.8% ,81.8% .There was not significant difference for MCA abnor‐mality between different area CI .The watershed infarction and lacunar infarction is the most common types of the 122 patients with MCA infarction and 34 patients with MCA stenosis .Conclusion ①TCD has a higher sensitivity and specificity for diagno‐sis of MCA stenosis and occlusion .The relevant rate of detecting results with TCD and MRA is higher .② It is causative for MCA stenosis in lacunar infarction ,watershed areas infarction and deep infarction ,leading to less complete infarction .③ Ar‐tery‐arterial embolism and low blood perfusion may play an important role in the pathogenesis of MCA stenosis infarction .