摘要
目的 通过分析颅内段颈内动脉狭窄程度与眼部动脉血流状态的相互关系,探讨二者互为预警指标的可行性.方法 在2015年11月至2016年5月期间对100例临床怀疑脑缺血并行头颈部CT血管成像(CTA)的患者一周内行眼部超声检查.adw4.4工作站图像后处理显示颅内段颈内动脉全程,测量最大狭窄程度,采用北美症状性颈动脉内膜切除试验(NASCET)方法将患者分成正常、轻、中、重四组;眼部超声分别测量眼动脉(OA)、视网膜中央动脉(CRA)、睫状后动脉(PCA)的收缩峰流速(PSV)、舒张峰流速(EDV)、阻力指数(RI)、搏动指数(PI).对狭窄程度严重侧的颈内动脉及同侧眼部血流数据行统计学分析.结果 颈内动脉无狭窄24例;轻度狭窄26例;中度狭窄30例;重度狭窄20例.OA PSV、EDV,CRA PSV、EDV及PCA PSV、EDV在颈内动脉正常、轻、中度狭窄组间血流改变无明显统计学差异(P>0.05);重度狭窄组中三根动脉PSV、EDV值较正常、轻度、中度明显下降(P<0.05).OA PSV在正常、轻度、中度、重度狭窄组中血流参数分别为:30.71±2.02 cm/s、30.53±5.59 cm/s、29.82±5.24 cm/s、26.06±6.63 cm/s.OA EDV在正常、轻度、中度、重度狭窄组中血流参数分别为:7.44±1.29 cm/s、7.38±2.35 cm/s、7.37±3.09 cm/s、5.79±2.47 cm/s.CRA PSV在正常、轻度、中度、重度狭窄组中血流参数分别为:9.71±2.46 cm/s、9.67±1.58 cm/s、9.08±1.81 cm/s、8.00±1.51 cm/s.CRA EDV在正常、轻度、中度、重度狭窄组中血流参数分别为:2.89±0.80 cm/s、2.81±0.90 cm/s、2.66±0.89 cm/s、2.23±0.71 cm/s.PCA PSV在正常、轻度、中度、重度狭窄组中血流参数分别为:11.57±1.42 cm/s、11.49±2.08 cm/s、11.33±2.70 cm/s、9.45±1.88 cm/s.PCA EDV在正常、轻度、中度、重度狭窄组中血流参数分别为:3.87±1.33 cm/s、3.79±1.39 cm/s、3.58±1.20 cm/s、2.73±0.65 cm/s.三根动脉血流参数在正常、轻、中三组间无统计学差异(P>0.05);重度狭窄组中三根动脉PSV、EDV值较正常、轻度、中度明显下降(P<0.05).眼部动脉血流参数中,ROC曲线下面积值最大者PCA PSV 为0.749,阈值11.85 cm/s.结论 眼部超声只对颈内动脉重度狭窄有预警价值.重度狭窄影响最明显的是PCA PSV,可作为预警重度狭窄指标.
Abstract
Objective By analyzing the relationship between intracranial internal carotid artery stenosis and ocular arterial blood flow,to explore the feasibility of the two indicators as surveillance index.Methods During November 2015 to May 2016,100 patients who was clinically suspected cerebral ischemia underwent head and neck CTA and intraocular ultrasound within one week.Adw4.4 work stationpost-process image to show the intracranial segment of the internal carotid artery then measure the maximum degree of the artery stenosis.All patients were divided into normal group,mild group,moderate group and severe group by NASCET.Ophthalmic ultrasonography was used to measure the ocular arteries (OA),central retinal (PSV),diastolic peak velocity (EDV),resistance index (RI) and pulsatility index (PI) were measured.The stenosis of the serious side of the carotid artery and ipsilateral eye blood flow data were statistically analyzed.Results Carotid artery mild stenosis 26 cases;moderate stenosis 30 cases;severe stenosis 20 cases,normal.24 cases.OA PSV,EDV,CRA PSV,EDV and PCA PSV,EDV in carotid artery normal,mild,moderate stenosis group shows no significant difference (P>0.05).The PSV and EDV values of three arteries in carotid artery severe stenosis group were significantly lower than normal,mild and moderate (P<0.05).The blood flow parameters of OA PSV in normal,mild,moderate,severe stenosis were: 30.71±2.02 cm/s,30.53±5.59 cm/s,29.82±5.24 cm/s,26.06±6.63 cm/s.The blood flow parameters of OA EDV in normal,mild,moderate,severe stenosis were: 7.44±1.29 cm/s,7.38±2.35 cm/s,7.37±3.09 cm/s,5.79±2.47 cm/s.The blood flow parameters of CRA PSV in normal,mild,moderate,severe stenosis were: 9.71±2.46 cm/s,9.67±1.58 cm/s,9.08±1.81 cm/s,8.00±1.51 cm/s.The blood flow parameters of CRA EDV in normal,mild,moderate,severe stenosis were: 2.89±0.80 cm/s,2.81±0.90 cm/s,2.66±0.89 cm/s,2.23±0.71 cm/s.The blood flow parameters of PCA PSV in normal,mild,moderate,severe stenosis were: 11.57±1.42 cm/s,11.49±2.08 cm/s,11.33±2.70 cm/s,9.45±1.88 cm/s.The blood flow parameters of PCA EDV in normal,mild,moderate,severe stenosis were: 3.87±1.33 cm/s,3.79±1.39 cm/s,3.58±1.20 cm/s,2.73±0.65 cm/s.Three arterial blood flow parameters has no statistically significant difference in normal,mild,moderate carotid artery stenosis (P>0.05).In the severe stenosis the value of PSV,EDV in three arteries decreased significantly than those in normal,mild,moderate stenosis (P<0.05).Among the eye arterial blood flow parameters,the greatest ROC area was PCA PSV 0.749,the threshold is 11.85 cm/s.Conclusion Ocular ultrasonography has only a warning value for severe stenosis of internal carotid artery.the PCA PSV is the most sensitive parameter in severe stenosis patients,can be used as an early warning indicator for severe stenosis.
基金项目
北京市医管局临床医学发展专项"扬帆"计划项目(XMLX201305)
科技北京百名领军人才培养工程项目(Z141107001514002)
NETL
NSTL
维普
万方数据