临床荟萃 ›› 2023, Vol. 38 ›› Issue (7): 613-617.doi: 10.3969/j.issn.1004-583X.2023.07.005

• 论著 • 上一篇    下一篇

多模态超声在高血压患者大脑中动脉狭窄筛查中的临床价值

李志勇(), 李星   

  1. 景德镇市第二人民医院 超声科,江西 景德镇 333000
  • 收稿日期:2023-06-19 出版日期:2023-07-20 发布日期:2023-09-01
  • 通讯作者: 李志勇 E-mail:448132882@qq.com
  • 基金资助:
    景德镇市科技计划项目——多模态超声在高血压患者大脑中动脉狭窄筛查中的临床价值(20221SFZC028)

Clinical value of multimodal ultrasound in screening middle cerebral artery stenosis in hypertensive patients

Li Zhiyong(), Li Xing   

  1. Department of Ultrasound, the Second People's Hospital of Jingdezhen, Jingdezhen 333000, China
  • Received:2023-06-19 Online:2023-07-20 Published:2023-09-01
  • Contact: Li Zhiyong E-mail:448132882@qq.com

摘要:

目的 探讨颈动脉超声联合经颅彩色多普勒超声(多模态超声)在高血压患者大脑中动脉狭窄筛查中的临床价值。方法 选取我院收治并接受颈动脉超声、经颅彩色多普勒超声(TCCD)、数字减影血管造影检查(DSA)的高血压患者60例,以大脑中动脉DSA结果分为试验组(狭窄组)30例,对照组(正常组)30例,分析2组颈动脉超声结构形态学和血流动力学变化,以及TCCD诊断大脑中动脉狭窄与DSA检查的一致性。结果 2组颈动脉内中膜厚度、斑块发生率比较,差异无统计学意义(P>0.05),试验组斑块累及血管数目,颈总动脉、颈内动脉狭窄发生率大于对照组,2组比较差异有统计学意义(P<0.05);2组患侧颈内动脉收缩期峰值流速比较,差异无统计学意义(P>0.05);试验组颈内动脉舒张末期流速低于对照组,阻力指数高于对照组,2组比较差异有统计学意义(P<0.05),Pearson相关性分析显示,患侧颈内动脉舒张末期流速与大脑中动脉狭窄呈负相关(r=-0.39),阻力指数与大脑中动脉狭窄呈正相关(r=0.28);TCCD诊断大脑中动脉狭窄程度与DSA的Kappa值为0.895(95%CI:0.756~1.034),诊断符合率为93.3%。结论 颈动脉超声结构形态学和血流动力学与大脑中动脉狭窄存在一定的相关性,具有一定的预警价值,联合TCCD可明确病变程度,且与DSA一致性较高,可作为高血压患者大脑中动脉狭窄筛查的首选手段。

关键词: 颈动脉超声, 经颅彩色多普勒超声, 多模态超声, 大脑中动脉狭窄, 高血压

Abstract:

Objective To explore the clinical value of multimodal ultrasound involving both carotid ultrasound and Transcranial color-coded duplex sonography (TCCD) in screening middle cerebral artery stenosis in hypertensive patients. Methods Sixty hypertensive patients admitted to our hospital who underwent carotid ultrasound, TCCD, and digital subtraction angiography (DSA) were selected as the study subjects. According to the presence of the middle cerebral artery stenosis detected by DSA or not, patients were divided into experimental group (middle cerebral artery stenosis, n=30) and control group (non-stenosis, n=30). The morphological and hemodynamic changes of carotid ultrasound were compared between groups. The consistency of the middle cerebral artery stenosis diagnosed by TCCD with that by DSA was analyzed. Results There were no significant differences in thickness of the carotid artery intima media and the incidence of plaques between experimental group and control group (P>0.05). The number of involved plaques, and the incidence of stenosis in the common carotid artery and internal carotid artery were significantly higher in the experimental group than those in the control group (P<0.05). There was no significant difference in the peak systolic flow velocity of the affected internal carotid artery between the two groups (P>0.05). The end diastolic flow velocity of the internal carotid artery in the experimental group was significantly lower than that in the control group, while the resistance index was significantly higher (P<0.05). Pearson correlation analysis showed that the end diastolic flow velocity of the affected internal carotid artery was negatively correlated with the middle cerebral artery stenosis (r=-0.39), and the resistance index was positively correlated with middle cerebral artery stenosis (r=0.28). The Kappa value of TCCD and DSA in diagnosing the middle cerebral artery stenosis was 0.895 (95%CI: 0.756-1.034), with a diagnostic accuracy of 93.3%. Conclusion There is a certain correlation of the morphology and hemodynamics of carotid ultrasound structure with the middle cerebral artery stenosis, which has a certain warning value. The combination of carotid ultrasound with TCCD is able to identify the degree of disease, showing a consistency with that diagnosed by DSA. It is preferred to the screening of the middle cerebral artery stenosis in hypertensive patients.

Key words: carotid ultrasound, transcranial color duplex sonography, multimodal ultrasound, middle cerebral artery stenosis, hypertension

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