摘要
目的 探讨超声血流动力学参数与颈动脉狭窄程度及短暂性脑缺血发作(TIA)相关性.方法 选取西安高新医院2022年11月～2023年10月收治的TIA患者(研究组,n=80)及同期健康体检者(对照组,n=80).以数字减影血管造影(DSA)为金标准将研究组细分为A组(轻度狭窄,n=30)、B组(中度狭窄,n=28)、C组(重度狭窄,n=22).研究组与对照组均进行DSA、超声检查,分析超声血流动力学参数及其与颈动脉狭窄程度相关性;多因素logistic回归分析血流动力学参数对TIA的影响;采用受试者工作特征(ROC)曲线分析血流动力学参数对TIA的诊断价值.结果 与对照组[(89.12±14.89)cm/s、(91.57±10.56)cm/s、(31.99±8.29)cm/s]比较,A组、B 组、C 组收缩期峰值血流速度(PSV)[(82.01±10.08)cmis、(76.81±9.01)cm/s、(71.68±8.04)cm/s]、舒张末期血流速度(EDV)[(87.06±9.62)cm/s、(82.01±9.01)cm/s、(77.02±8.12)cm/s]、平均血流速度(MV)[(27.58±9.13)cm/s、(22.15±9.63)cm/s、(17.46±4.12)cm/s]低于对照组,且 B 组、C 组低于 A组,C 组低于 B 组(P＜0.05);C 组搏动指数(PI,1.52±0.40)、阻力指数(RI,1.11±0.03)高于 A 组[(1.19±0.34)、(0.71±0.22)]、B 组[(1.22±0.37、0.81±0.28)]及对照组[(1.52±0.40、1.11±0.03)],B 组 RI 高于对照组[(0.81±0.28)比(0.62±0.24),P＜0.05];颈动脉狭窄程度与 PSV、EDV、MV 呈负相关性(r=-0.786、-0.767、-0.541,P＜0.05);颈动脉狭窄程度与 PI、RI 呈弱正相关性(r=0.28 l、0.318,P＜0.05);PSV(OR=3.047,95％CI 1.602～5.794)、EDV(OR=2.743,95％CI 1.509～4.987)、MV降低(OR=1.887,95％CI 1.238～2.876)、高血压(OR=1.926,95％CI 1.356～3.772)、糖尿病(OR=2.104,95％CI 1.473～3.030)均是导致TIA 的独立危险因素(P＜0.05);PSV、EDV、MV单独及联合评估 TIA,AUC 分别为 0.773(0730～0.813).0.729(0.683～0.771)、0.719(0.673～0.762)、0.942(0.913～0.963),三项指标联合评估效能优于各指标单独检测(P＜0.05).结论 超声血流动力学参数可监测TIA患者血流动力学变化,其中PSV、EDV、MV与颈动脉狭窄程度密切相关,可作为诊断TIA的可靠依据.
Abstract
Objective To explore the correlation between ultrasound hemodynamic parameters and the degree of carotid artery stenosis and transient ischemic attack(TIA).Methods TIA patients(the study group,n=80)admitted to Xi'an Hi-tech Hospital from November 2022 to October 2023 and healthy physical examination subjects(the control group,n=80)in the same period were selected.The study group was subdivided into Group A(mild stenosis,n=30),Group B(moderate stenosis,n=28),and Group C(severe stenosis,n=22)using digital subtraction angiography(DSA)as the gold standard.DSA and ultrasound were performed in both the study group and control group,and the correlation between ultrasound hemodynamic parameters and the degree of carotid artery stenosis was analyzed.The influence of hemodynamic parameters on TIA was analyzed by multivariate logistic regression.The diagnostic value of hemodynamic parameters for TIA was analyzed using receiver operating characteristic(ROC)curves.Results Compared with control group[(89.12±14.89)cm/s,(91.57±10.56)cm/s,(31.99±8.29)cm/s],peak systolic blood velocity(PSV)[(82.01±10.08)cm/s,(76.81±9.01)cm/s,(71.68±8.04)cm/s],end diastolic blood velocity(EDV)[(87.06±9.62)cm/s,(82.01±9.01)cm/s,(77.02±8.12)cm/s]and mean flow velocity(MV)[(27.58±9.13)cm/s,(22.15±9.63)cm/s,(17.46±4.12)cm/s]were lower,and groups B and C were lower than group A,and group C was lower than group B(P＜0.05).The pulse index(PI,1.52±0.40),resistance index(RI,1.11±0.03)in group C were higher than groups A[(1.19±0.34)、(0.71±0.22)],group B[(1.22±0.37、0.81±0.28)]and control group[(1.52±0.40、l.l1±0.03)],and RI in group B was higher than control group[(0.81±0.28)vs.(0.62±0.24),P＜0.05].The degree of carotid stenosis showed a negative correlation with PSV,EDV and MV(r=-0.786,-0.767,-0.541,P＜0.05).The degree of carotid artery stenosis showed a weak positive correlation with PI and RI(r=0.281,0.318,P＜0.05).PSV(OR=3.047,95％CI 1.602-5.794),EDV(OR=2.743,95％CI 1.509-4.987),MV decrease(OR=1.887,95％CI 1.238-2.876),hypertension(OR=1.926,95％CI 1.356-3.772)and diabetes mellitus(OR=2.104,95％CI 1.473-3.030)were all the independent risk factors for TIA(P＜0.05).PSV,EDV and MV alone and combined to evaluate the TIA,AUC was 0.773(0730-0.813),0.729(0.683-0.771),0.719(0.673-0.762),0.942(0.913-0.963),respectively.Conclusion Ultrasound hemodynamic parameters can monitor hemodynamic changes in TIA patients,among which PSV,EDV and MV are closely related to the degree of carotid artery stenosis,and can serve as a reliable basis for diagnosing TIA.
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