主动脉内径和弹性改变与颅内动脉瘤的相关性研究
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摘要
颅内动脉瘤是由于局部血管异常改变产生的脑血管瘤样突起,是造成蛛网膜下腔出血的首位病因。脑血管意外中,颅内动脉瘤破裂出血仅次于脑血栓、高血压脑出血,位居第三。临床上颅内动脉瘤破裂前多无症状,诊断也较为困难,常常在并发出血时才被发现,且存活者中50-70%遗留有严重的残疾,给社会和家庭带来沉重的负担,因而迫切需要早期监测指标来降低该病的致残率及死亡率。颅内动脉瘤的发病是多因素的,先天性血管壁发育不良、颅内动脉获得性退行性病变导致血管破坏被认为是颅内动脉瘤的发病原因之一。颅内动脉瘤自身的研究现已多见,但目前尚未见对该病的大血管结构及弹性功能的报道。因此,我们应用无创的经胸超声心动图,以升主动脉及腹主动脉内径、升主动脉弹性功能为主要指标进行了以下两部分研究,希望能为颅内动脉瘤的病因学研究及临床早期监测提供依据。
第一部分升主动脉、腹主动脉内径与颅内动脉瘤的相关性研究
研究背景
术中影像和病理学研究表明先天性血管壁发育不良、颅内动脉获得性退行性病变是颅内动脉瘤的发病原因之一。但颅内动脉瘤患者的大动脉,如升主动脉、腹主动脉内径大小；是否易发升主动脉、腹主动脉瘤等情况不甚明了。因此,为了解颅内动脉瘤患者的升主动脉、腹主动脉内径与颅内动脉瘤的相关性,我们对107例颅内动脉瘤患者的主动脉内径进行了详细分析并加以统计分析。
目的
评估颅内动脉瘤患者的升主动脉、腹主动脉内径与颅内动脉瘤的相关性。
方法
选择经DSA确诊的107例颅内动脉瘤患者(其中伴发高血压者57例)及108例健康者为正常对照,经胸二维超声心动图分别测量并比较各组舒张末期升主动脉、腹主动脉各段内径。
结果
颅内动脉瘤高血压组、非高血压组与对照组经体表面积校正后的主动脉各段内径各组间均值均无统计学差异,单因素相关分析表明升主动脉、腹主动脉内径大小与颅内动脉瘤无相关性(P>0.05)。
结论
颅内动脉瘤患者各段主动脉内径径线无明显改变。因此临床上不能以主动脉各段内径的大小作为颅内动脉瘤的发生及病情发展的检测指标。
第二部分颅内动脉瘤患者主动脉弹性功能的研究
研究背景
动脉弹性功能减退是多种心脑血管危险因素对血管壁早期损害的综合表现。是早期血管病变的特异性和敏感性标志；而且也是一种心脑血管疾病的高危因素,参与了心脑血管疾病的发生和发展。近年来,无创评价动脉弹性功能主要用于心血管疾病的研究,而在脑血管疾病中的应用鲜为少见。本次研究以颅内动脉瘤为研究对象,运用M型超声心动图测量颅内动脉瘤患者的升主动脉内径,计算并评价该组疾患的动脉弹性功能变化,以期为颅内动脉瘤的病因学研究及临床早期防治提供可靠依据。
目的
评价颅内动脉瘤患者主动脉弹性功能变化及临床意义。
方法
选择107例颅内动脉瘤患者(其中伴发高血压者57例)和108例正常对照者,M型超声心动图测量升主动脉收缩期(AoS)及舒张期(AoD)内径,计算并比较各组主动脉弹性功能指标。
结果
①与正常对照组比较：颅内动脉瘤高血压组、非高血压组患者的主动脉膨胀性均(aortic distensibility, DIS)明显降低(P<0.001),而僵硬度(aortic stiffness index, SI)均明显增加(P<0.001)。
②与颅内动脉瘤非高血压组比较：伴有高血压的颅内动脉瘤患者DIS明显降低(P<0.001),而SI有所升高(P<0.05,ANOVA).三组间经体表面积、体重指数校正后的校正值亦存在同样规律。
结论
颅内动脉瘤患者均存在主动脉弹性功能的减退,且高血压是引起该组疾患主动脉弹性功能进一步减退的原因之一。因此早期无创超声评估颅内动脉瘤患者的大动脉弹性功能对其临床治疗及预后具有重要意义。
Intracranial aneurysm (IAs) is the weakness of intracranial vessels that balloons out and is apt to rupture. It is the most dangerous brain disease because of high mortality and morbidity. Cerebrovascular disease is the third leading cause of death worldwide. And rupture of intracranial aneurysms is responsible for one-fourth cerebrovascular deaths. In spite of surgical and pharmacological treatment, nearly half of the aneurysmal subarachnoid hemorrhage (SAH) patients die. Therefore, early diagnosis and prevention of IA should be a major healthcare concern in order to reduce morbidity and mortality. Etiology studies indicate that IA is related to congenital vessel wall dysplasia and acquired intracranial arterial degenerative diseases. To investigate the blood vessels of patients with IAs, we studied the aortic diameter and aortic elastic properties in IAs patients.
Part I Correlation Analysis of Aortic Diameter and Intracranial Aneurysms
Backgroud
Previous studies showed that the vascular wall of congenital dysplasia and acquired intracranial arterial degenerative disease are the causes of IAs. The relationship between aortic diameter and IAs remains unclear. This study was performed to assess the correlation between aortic diameter and IAs.
Methods
107IAs patients (57patients with hypertension) and108control subjects were recruited. The internal aortic diameters in diastole were measured by transthoracic two-dimensional echocardiography.
RESULTS
Aortic diameter adjusted by body surface area in various echocardiographic section had no significant differences between IAs-HP, IAs-NHP and control group (P>0.05). Univariate analyses showed the aortic diameter was not associated with IAs.
CONCLUSISONS
The aortic diameter was not associated with IAs. Therefore, the aortic diameter was unlikely useful in early diagnoses and prevention of IAs.
Part II Aortic elastic properties and its clinical significance in IAs
Backgroud
Increased large artery stiffness was an risk factor of vascular diseases. Intracranial aneurysms (IAs) occurrence is related to congenital vessel wall dysplasia and acquired intracranial arterial degenerative diseases. Therefore, the assessment of aortic mechanical properties is of particularly importance in understanding vascular disease mechanisms. This study investigated the relationship between the aortic elastic properties and IAs.
Methods
107IAs patients (57patients with hypertension) and108control subjects were recruited. The internal aortic diameter was measured3cm above the aortic valve during systole and diastole phases by M-mode echocardiography, and the aortic elasticity index was calculated.
RESULTS
①ompared to the controls, aortic distensibility was significantly decreased in IAs patients (P<0.001), while aortic stiffness index was significantly increased in IAs (P<0.001).
②ompared to the patients with IAs who did not have hypertension(IAs-NHP), aortic distensibility was significantly decreased in patients with hypertensive IAs (IAs-HP)(P<0.001), while aortic stiffness index was significantly increased (P<0.001). Similar results were obtained when the aortic elasticity index was adjusted for body surface area and body mass index.
CONCLUSIONS
IAs appears to correlate with abnormal aortic elasticity, and hypertension is closely related to the severity of aortic elasticity. Therefore, Abnormal aortic elasticity assessed by non-invasive ultrasound is helpful in the diagnosis and prognosis of IAs.
第一部分升主动脉、腹主动脉内径与颅内动脉瘤的相关性研究
研究背景
术中影像和病理学研究表明先天性血管壁发育不良、颅内动脉获得性退行性病变是颅内动脉瘤的发病原因之一。但颅内动脉瘤患者的大动脉,如升主动脉、腹主动脉内径大小；是否易发升主动脉、腹主动脉瘤等情况不甚明了。因此,为了解颅内动脉瘤患者的升主动脉、腹主动脉内径与颅内动脉瘤的相关性,我们对107例颅内动脉瘤患者的主动脉内径进行了详细分析并加以统计分析。
目的
评估颅内动脉瘤患者的升主动脉、腹主动脉内径与颅内动脉瘤的相关性。
方法
选择经DSA确诊的107例颅内动脉瘤患者(其中伴发高血压者57例)及108例健康者为正常对照,经胸二维超声心动图分别测量并比较各组舒张末期升主动脉、腹主动脉各段内径。
结果
颅内动脉瘤高血压组、非高血压组与对照组经体表面积校正后的主动脉各段内径各组间均值均无统计学差异,单因素相关分析表明升主动脉、腹主动脉内径大小与颅内动脉瘤无相关性(P>0.05)。
结论
颅内动脉瘤患者各段主动脉内径径线无明显改变。因此临床上不能以主动脉各段内径的大小作为颅内动脉瘤的发生及病情发展的检测指标。
第二部分颅内动脉瘤患者主动脉弹性功能的研究
研究背景
动脉弹性功能减退是多种心脑血管危险因素对血管壁早期损害的综合表现。是早期血管病变的特异性和敏感性标志；而且也是一种心脑血管疾病的高危因素,参与了心脑血管疾病的发生和发展。近年来,无创评价动脉弹性功能主要用于心血管疾病的研究,而在脑血管疾病中的应用鲜为少见。本次研究以颅内动脉瘤为研究对象,运用M型超声心动图测量颅内动脉瘤患者的升主动脉内径,计算并评价该组疾患的动脉弹性功能变化,以期为颅内动脉瘤的病因学研究及临床早期防治提供可靠依据。
目的
评价颅内动脉瘤患者主动脉弹性功能变化及临床意义。
方法
选择107例颅内动脉瘤患者(其中伴发高血压者57例)和108例正常对照者,M型超声心动图测量升主动脉收缩期(AoS)及舒张期(AoD)内径,计算并比较各组主动脉弹性功能指标。
结果
①与正常对照组比较：颅内动脉瘤高血压组、非高血压组患者的主动脉膨胀性均(aortic distensibility, DIS)明显降低(P<0.001),而僵硬度(aortic stiffness index, SI)均明显增加(P<0.001)。
②与颅内动脉瘤非高血压组比较：伴有高血压的颅内动脉瘤患者DIS明显降低(P<0.001),而SI有所升高(P<0.05,ANOVA).三组间经体表面积、体重指数校正后的校正值亦存在同样规律。
结论
颅内动脉瘤患者均存在主动脉弹性功能的减退,且高血压是引起该组疾患主动脉弹性功能进一步减退的原因之一。因此早期无创超声评估颅内动脉瘤患者的大动脉弹性功能对其临床治疗及预后具有重要意义。
Intracranial aneurysm (IAs) is the weakness of intracranial vessels that balloons out and is apt to rupture. It is the most dangerous brain disease because of high mortality and morbidity. Cerebrovascular disease is the third leading cause of death worldwide. And rupture of intracranial aneurysms is responsible for one-fourth cerebrovascular deaths. In spite of surgical and pharmacological treatment, nearly half of the aneurysmal subarachnoid hemorrhage (SAH) patients die. Therefore, early diagnosis and prevention of IA should be a major healthcare concern in order to reduce morbidity and mortality. Etiology studies indicate that IA is related to congenital vessel wall dysplasia and acquired intracranial arterial degenerative diseases. To investigate the blood vessels of patients with IAs, we studied the aortic diameter and aortic elastic properties in IAs patients.
Part I Correlation Analysis of Aortic Diameter and Intracranial Aneurysms
Backgroud
Previous studies showed that the vascular wall of congenital dysplasia and acquired intracranial arterial degenerative disease are the causes of IAs. The relationship between aortic diameter and IAs remains unclear. This study was performed to assess the correlation between aortic diameter and IAs.
Methods
107IAs patients (57patients with hypertension) and108control subjects were recruited. The internal aortic diameters in diastole were measured by transthoracic two-dimensional echocardiography.
RESULTS
Aortic diameter adjusted by body surface area in various echocardiographic section had no significant differences between IAs-HP, IAs-NHP and control group (P>0.05). Univariate analyses showed the aortic diameter was not associated with IAs.
CONCLUSISONS
The aortic diameter was not associated with IAs. Therefore, the aortic diameter was unlikely useful in early diagnoses and prevention of IAs.
Part II Aortic elastic properties and its clinical significance in IAs
Backgroud
Increased large artery stiffness was an risk factor of vascular diseases. Intracranial aneurysms (IAs) occurrence is related to congenital vessel wall dysplasia and acquired intracranial arterial degenerative diseases. Therefore, the assessment of aortic mechanical properties is of particularly importance in understanding vascular disease mechanisms. This study investigated the relationship between the aortic elastic properties and IAs.
Methods
107IAs patients (57patients with hypertension) and108control subjects were recruited. The internal aortic diameter was measured3cm above the aortic valve during systole and diastole phases by M-mode echocardiography, and the aortic elasticity index was calculated.
RESULTS
①ompared to the controls, aortic distensibility was significantly decreased in IAs patients (P<0.001), while aortic stiffness index was significantly increased in IAs (P<0.001).
②ompared to the patients with IAs who did not have hypertension(IAs-NHP), aortic distensibility was significantly decreased in patients with hypertensive IAs (IAs-HP)(P<0.001), while aortic stiffness index was significantly increased (P<0.001). Similar results were obtained when the aortic elasticity index was adjusted for body surface area and body mass index.
CONCLUSIONS
IAs appears to correlate with abnormal aortic elasticity, and hypertension is closely related to the severity of aortic elasticity. Therefore, Abnormal aortic elasticity assessed by non-invasive ultrasound is helpful in the diagnosis and prognosis of IAs.
引文
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[10]崔嘉萍,刘兰燕,赵金惠,等.扩张型心肌病患者主动脉弹性改变的初步研究.中华临床医师杂志,2009,7(3)：1164-1169.
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[3]王宏宇,胡大一.动脉僵硬度与心血管疾病.中国医刊,2004,39(2)：61-62.
[4]张文云,李徽.高血压动脉弹性功能的研究进展.河北医药,2005,27(9)：698-699.
[5]Viachopoulos C, Aanaouridis K, Stefanadis C. Prediction of cardio-vascular events and all-cause mortality with arterial stiffness:a systematic review and meta-analysis. J Am Coll Cardiol,2010; 55:1318-1327.
[6]Meyers PM, Schumacher HC, Higashida RT. Reporting standards for endovascular repair of saccular intracranial cerebral aneurysms. Stroke, 2009; 40:e366-379.
[7]Hansen F, Bergqvist D, Mangell P, Ryden A, Sonesson B, Lanne T. Non-invasive measurement of pulsatile vessel diameter change and elastic properties in human arteries:a methodological study. Clin Physiol,1993, 13 (6):631-643.
[8]Shau YW, Wang CL, Shieh JY, Hsu TC. Noninvasive assessment of the iscoelasticity of peripheral arteries. Ultrasound Med Biol,1999,25(9): 1377-1388.
[9]Nistri S, Grande-Allen J, Basso C, Basso C, Siviero P, Maggi S, Crepaldi G, Thiene G.. Aortic elasticity and size in bicuspid aortic valve syndrome. Eur Heart J,2008; 29:472-479.
[10]崔嘉萍,刘兰燕,赵金惠,等.扩张型心肌病患者主动脉弹性改变的初步研究.中华临床医师杂志,2009,7(3)：1164-1169.
[11]康卫华,王萍,王雪梅.兔腹主动脉血管弹性的超声及实验研究.使用老年医学,2002,22(2)：122-124.
[12]熊建群,谌谨寰.M型超声探测腹主动脉弹性的初步分析.中国现代医学杂志,2002,12(6)：77-78.
[13]Eriksson A, Greife E, Loupas T, Hasegawa T, Koshaka S, Palmieri V, Elkind MS, Homma S, Sacco RL, Di Tullio MR. Arterial pulse wave velocity with tissue Doppler imaging. Ultrasound Med Biol,2002,28(5): 571-580.
[14]Ganong WE eview of medical physiology. San Francisco: Appleton&Lange,1987:466-476.
[15]陆永萍,黄燕玲,王嫱,等.定量组织多普勒及应变率成像对正常人升主动脉弹性的研究.中华医学超声杂志,2008,5：931一936.
[16]Eryol NK, Topsakal R, Cicek Y, Abaci A, Oguzhan A, Basar E, Ergin A. Color doppler tissue imaging in assessing the elastic properties of the aorta and in predicting coronary artery disease. Jpn Heart J,2002,43(3): 219-230.
[17]黄瑛,黄品同,杨琰,等.应用多普勒组织成像技术对高血压患者动脉弹性的研究.中国超声诊断杂志,2005,6(2)：90-94.
[18]黄品同,黄福光,杨鹏麟,等.多普勒组织成像对正常中年人腹主动脉壁运动的初步研究.中华超声影像学杂志,2003,12(2)：115-117.
[19]Isnard RN, Pannier BM, Laurent S, London GM, Diebold B, Safar ME. Pulsatile diameter and elastic modulus of the aortic arch in essential hypertension:a noninvasive study. J Am Coll Cardiol,1989,13(2): 399-405.
[20]Asmar R, Benetos A, London G, Hugue C, Weiss Y, Topouchian J, Laloux B, Safar M. Aortic distensibility in normotensive, untreated and treated hypertensive patients. Blood Press,1995,4(1):48-54.
[21]Schmidt-trucksass A, Grathwohl D, Schmid A, Boragk R, Upmeier C, Keul J, Huonker M. Assessment of carotid wall motion and stiffness with tissue Doppler imaging. Ultrasound Med Biol,1998,24(5):639-646.
[22]王淑敏,王金锐,杨敬瑛,等.应用组织速度成像技术对颈总动脉壁弹性特征的研究.中国超声医学杂志,2004,20(6)：429-432.
[23]Abraham TP, Nishimura RA, Holmes DR Jr, Belohlavek M, Seward JB. Strain rate imaing for assessment of regional myocardial function:results from a clinical model of septal ablation, circulation,2002,105(12): 1403-1406.
[24]郑孝志,季平,茅红卫.高血压病患者升主动脉弹性的应变率评价.临床超声医学杂志,2007,9(2)：88-90.
[25]郑孝志,季平,茅红卫.高血压病患者腹主动脉弹性的应变率评价.中国超声医学杂志,2008,24(8)：735-737
[26]王淑敏,杨敬英,王建华,等.应变和应变率显像技术对颈总动脉壁顺应性的研究.内蒙古医学杂志,2007,39(3)：287-289.
[27]方玲玲,张平洋.超声心动图应变和应变率成像的临床应用新进展.心血管病学进展,2010,31(1)：88-92.