颈动脉狭窄患者的椎动脉血流动力学改变
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摘要
目的探讨颈动脉狭窄(CAS)患者椎动脉血流动力学改变。方法对65例住院患者行颈动脉超声检查,测量颈动脉内膜中层厚度(IMT)及椎动脉血流流速,并分析CAS椎动脉血流动力学改变的危险因素。结果依据颈动脉血管狭窄超声诊断标准分为CAS组21例(32.3%),非颈动脉狭窄组(NCAS)44例(67.7%)。CAS组IMT厚度大于非CAS组(P<0.05),CAS组的双侧椎动脉收缩期峰值流速(PSV)均大于非CAS组(P<0.05),而双侧椎动脉内径及阻力指数之间差异无统计学意义。logistic回归分析显示双侧椎动脉的PSV为CAS的危险因素。结论 CAS引起椎动脉血流动力学变化。
Objective To investigate the changes of hemodynamics of vertebral artery in patients with carotid artery stenosis( CAS). Methods A total of 65 subjects have been enrolled into the study cohort. Carotid intima-media thickness( IMT),and vertebral artery flow velocity were measured by ultrasound. Risk factors of hemodynamics changes in the vertebral artery were identified in patients with CAS. Results According to the ultrasound diagnostic criteria for vascular stenosis,21 cases( 32. 3%) were classified into CAS group and 44 cases( 67. 7%) in non-carotid artery stenosis group( NCAS). The IMT in CASs was thicker than that in NCASs( P < 0. 05). The peak systolic velocities( PSV)of bilateral vertebral arteries in CASs were thicker than that in NCASs( P < 0. 05). However,there were no significant difference in the diameters and RI between CASs and NCASs. Logistic regression analysis showed that PSVs of vertebral artery were a risk factor for CAS. Conclusion CAS impaires hemodynamics of vertebral artery,and significantly increases blood flow velocity in vertebral artery.
Objective To investigate the changes of hemodynamics of vertebral artery in patients with carotid artery stenosis( CAS). Methods A total of 65 subjects have been enrolled into the study cohort. Carotid intima-media thickness( IMT),and vertebral artery flow velocity were measured by ultrasound. Risk factors of hemodynamics changes in the vertebral artery were identified in patients with CAS. Results According to the ultrasound diagnostic criteria for vascular stenosis,21 cases( 32. 3%) were classified into CAS group and 44 cases( 67. 7%) in non-carotid artery stenosis group( NCAS). The IMT in CASs was thicker than that in NCASs( P < 0. 05). The peak systolic velocities( PSV)of bilateral vertebral arteries in CASs were thicker than that in NCASs( P < 0. 05). However,there were no significant difference in the diameters and RI between CASs and NCASs. Logistic regression analysis showed that PSVs of vertebral artery were a risk factor for CAS. Conclusion CAS impaires hemodynamics of vertebral artery,and significantly increases blood flow velocity in vertebral artery.
引文
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[2]BADACZ R,KABAK-ZIEMBICKA A,URBAN'CZYKZAWADZKA M,et al.Magnetic resonance imaging and clinical outcome in patients with symptomatic carotid artery stenosis after carotid artery revascularization[J].Postepy Kardiol Interwencyjnej,2017,13(3):225-232.
[3]DANKBAAR J W,KERCKHOFFS K G P,HORSCH A D,et al.Internal carotid artery stenosis and collateral recruitment in stroke patients[J].Clin Neuroradiol,2017,24(1):1-6.
[4]陈静,顾朋颖,丁琪,等.老年缺血性卒中患者血胆红素水平与颈动脉粥样硬化的相关性[J].中国临床保健杂志,2017,20(6):696-699.
[5]华扬,郑宇,凌晨,等.动脉粥样硬化危险因素与颈动脉狭窄和缺血性卒中的相关性[J].中国脑血管病杂志,2004,1(2):69-72.
[6]STEINBUCH J,VAN DIJK A C,SCHREUDER F,et al.Definition of common carotid wall thickness affects risk classification in relation to degree of internal carotid artery stenosis:the Plaque At RISK(PARISK)study[J].Cardiovasc Ultrasound,2017,15(1):9.
[7]OKAMURA M,TAKEKAWA H,OKABE R,et al.Vertebral artery doppler waveform patterns for exclusive diagnosis of basilar artery stenosis and occlusion[J].J Med Ultrason,2016,43(1):83-89.
[8]KHANGURE S R,BENHABIB H,MACHNOWSKA M,et al.Carotid near-occlusion frequently has high peak systolic velocity on Doppler ultrasound[J].Neuroradiology,2018,60(1):17-25.
[9]SANTOS E H S,SANTOS NETO P J D,SANTOS I S.Carotid intima-media thickness in the Brazilian Longitudinal Study of Adult Health(ELSA-Brasil):a narrative review[J].Sao Paulo Med J,2018,136(1):64-72.