摘要
目的 探究血液流变学指标及脑血流灌注量与慢性脑供血不足患者脑供血动脉狭窄的关系.方法 回顾性选取2021年1月至2023年10月在铜川市人民医院就诊的96例慢性脑供血不足患者作为观察组.根据脑供血动脉狭窄程度,将其分为轻中度狭窄组(n=36)和重度狭窄组(n=60).另选同期96名健康体检者纳入对照组.检测与比较观察组与对照组、轻中度狭窄组和重度狭窄组的血液流变学指标(全血高切黏度、全血低切黏度、血浆黏度、纤维蛋白原)水平、脑血流灌注量;使用多因素Logistic回归分析血液流变学指标及脑血流灌注量与慢性脑供血不足患者脑供血动脉重度狭窄的关系;使用受试者操作特征(ROC)曲线分析血液流变学指标及脑血流灌注量对慢性脑供血不足患者脑供血动脉重度狭窄的预测效能.结果 观察组的全血高切黏度、全血低切黏度、血浆黏度、纤维蛋白原水平分别为(9.12±1.57)mPa/s、(42.12±4.56)mPa/s、(2.38±0.45)mPa/s、(3.96±0.58)g/L,均高于对照组[(7.20±0.86)mPa/s、(30.25±2.07)mPa/s、(1.61±0.23)mPa/s、(2.41±0.29)g/L],脑血流灌注量为(542.12±45.63)mL/min,少于对照组(661.25±67.84)mL/min,差异均有统计学意义(P＜0.05).重度狭窄组的全血高切黏度、全血低切黏度、血浆黏度、纤维蛋白原水平分别为(9.94±1.80)mPa/s、(49.37±5.26)mPa/s、(2.97±0.61)mPa/s、(4.65±0.73)g/L,均高于轻中度狭窄组[(8.36±1.35)mPa/s、(35.68±3.14)mPa/s、(2.05±0.34)mPa/s、(3.24±0.37)g/L],脑血流灌注量为(520.16±40.78)mL/min,少于轻中度狭窄组[(589.42±52.17)mL/min],差异均有统计学意义(P＜0.05).经多因素Logistic回归分析,血浆黏度、纤维蛋白原和脑血流灌注量均是慢性脑供血不足患者脑供血动脉重度狭窄的独立预测因素(P＜0.05).经ROC曲线分析,血浆黏度、纤维蛋白原、脑血流灌注量预测慢性脑供血不足患者脑供血动脉重度狭窄的曲线下面积(AUC)分别为0.626、0.655、0.640,联合预测的AUC为0.924,大于单项指标的AUC(P＜0.05).结论 血液流变学指标及脑血流灌注量与慢性脑供血不足患者脑供血动脉狭窄程度密切相关,其中血浆黏度、纤维蛋白原联合脑血流灌注量预测脑供血动脉重度狭窄的效能较好.
Abstract
Objective To explore the relationship between hemorheology indexs,cerebral blood perfusion volume and cerebral artery ste-nosis in patients with chronic cerebral insufficiency.Methods 96 patients with chronic cerebral ischemia who visited Tongchuan People's Hospital from January 2021 to October 2023 were retrospectively selected as the observation group.According to the degree of brain artery stenosis,they were divided into the mild-to-moderate stenosis(n=36)and the severe stenosis group(n=60).At the same time,96 healthy subjects were included in the control group.The levels of hemorheological indexs(whole blood high shear viscosity,whole blood low shear viscosity,plasma vis-cosity,fibrinogen)and cerebral blood flow perfusion were detected and compared between the observation group and the control group,the mild to moderate stenosis group and the severe stenosis group.The relationship between hemorheology indexes and cerebral blood flow perfusion and severe stenosis of cerebral artery in patients with chronic cerebral insufficiency was analyzed by multivariate Logistic regression analysis.The predictive ef-ficacy of hemorheological indexs and cerebral blood flow perfusion on severe cerebral artery stenosis in patients with chronic cerebral ischemia was analyzed using receiver operating characteristic(ROC)curves.Results The whole blood high shear viscosity,whole blood low shear viscosity,plasma viscosity,and fibrinogen water in the observation group were(9.12±1.57)mPa/s,(42.12±4.56)mPa/s,(2.38±0.45)mPa/s,and(3.96±0.58)g/L,respectively,which were higher than those in the control group[(7.20±0.86)mPa/s,(30.25±2.07)mPa/s,(1.61±0.23)mPa/s,and(2.41±0.29)g/L],and the cerebral blood flow perfusion was(542.12±45.63)mL/min,which was lower than that in the control group[(661.25±67.84)mL/min],the differences were statistically significant(P＜0.05).The whole blood high shear vis-cosity,whole blood low shear viscosity,plasma viscosity,and fibrinogen levels in the severe stenosis group were(9.94±1.80)mPa/s,(49.37±5.26)mPa/s,(2.97±0.61)mPa/s,and(4.65±0.73)g/L,respectively,which were higher than those in the mild to moderate stenosis group[(8.36±1.35)mPa/s,(35.68±3.14)mPa/s,(2.05±0.34)mPa/s,and(3.24±0.37)g/L],the cerebral blood flow perfusion was(520.16±40.78)mL/min,which was lower than that in the mild to moderate stenosis group[(589.42±52.17)mL/min,the differences were statistically significant(P＜0.05).The multi-factor Logistic regression analysis,plasma viscosity,fibrinogen and cerebral blood flow perfu-sion are supplying artery of patients with chronic brain is an independent predictor of severe stenosis(P＜0.05).The ROC curve analysis,plas-ma viscosity,fibrinogen,cerebral blood flow perfusion measure prediction supplying artery of severe stenosis of patients with chronic brain area un-der the curve(AUC)were 0.626,0.655,0.640,combined prediction of AUC was 0.924,was greater than the single parameter AUC(P＜0.05).Conclusion Hemorheology indexs and cerebral blood flow perfusion and supplying artery stenosis degree is closely related to the patients with chronic brain,blood plasma viscosity,fibrinogen in combination with cerebral blood flow perfusion better predict the efficiency of the suppl-ying artery of severe stenosis.
基金项目
陕西省中医药管理局项目(2021-ZZ-LC008)
NETL
NSTL
万方数据