摘要
目的探讨经颅多普勒超声(TCD)对椎动脉盗血频谱的分类诊断的价值。方法收集和分析TCD显示一侧椎动脉呈盗血血流频谱同时行颈部CT血管成像(CTA)或磁共振血管成像(MRA)检查的22例病例的临床和影像学检查资料。TCD对椎动脉盗血严重程度分级,CTA和MRA评价血管的狭窄程度。病例分为单纯锁骨下动脉狭窄、锁骨下动脉狭窄伴患侧椎动脉纤细或狭窄、单纯椎动脉盗血3组,并分析3组间临床指标和椎动脉TCD参数。结果22例病例中,单纯锁骨下动脉狭窄者10例,锁骨下动脉狭窄伴患侧椎动脉纤细或狭窄者7例,单纯椎动脉盗血5例。单纯锁骨下动脉狭窄组、锁骨下动脉狭窄伴患侧椎动脉纤细或狭窄组、单纯椎动脉盗血组女性发病率分别为10%、40%、60%,右侧发生率分别为10%、57%、40%,隐匿型盗血的发生率分别为0、43%、60%,平均年龄分别为68岁、68岁、78岁。单纯椎动脉盗血组患侧椎动脉反向峰值流速(48±34)cm/s,单纯锁骨下动脉狭窄组、锁骨下动脉狭窄伴患侧椎动脉纤细或狭窄组患侧椎动脉反向峰值流速(9±14)cm/s,2组比较有统计学差异(Z=-2.219,P=0.026)。利用测量患侧椎动脉反向峰值流速来鉴别单纯椎动脉盗血的曲线下面积(AUC)为0.829,当以18 cm/s为界值时,敏感性为76.5%,特异性为80%。结论左侧锁骨下动脉狭窄是引起椎动脉出现盗血流频谱最常见的原因。当椎动脉盗血频谱表现为隐匿型、病变在右侧、患者为女性、年龄>70岁时,需考虑伴椎动脉纤细或狭窄,或单纯椎动脉盗血的可能。患侧椎动脉反向峰值流速对于诊断单纯椎动脉盗血有帮助。
Objective To investigate the value of transcranial Doppler in the classification and diagnosis of vertebral artery steal spectrum.Methods The clinical and imaging data(TCD and CTA/MRA)of 22 cases with TCD showing vertebral artery steal spectrum,which had neck CT angiography(CTA)or magnetic resonance angiography(MRA),were collected and analyzed.According to the severity of blood stealing graded by TCD and the degree of vascular stenosis evaluated by CTA or MRA,the cases were divided into three groups:the group of simple subclavian artery stenosis(G1),the group of subclavian artery stenosis with ipsilateral severe stenosis or fine vertebral artery(G2),and the group of simple vertebral artery steal(G3).The differences of clinical indexes and TCD parameters among the three groups were analyzed.Results Among the 22 cases,there were 10 cases of G1,7 cases of G2,and 5 cases of G3.The incidence rates of female patients in G1-3 were 10%,40%and 60%,respectively.The incidence rates of right side in G1-3 were 10%,57%and 40%,respectively.The incidence rates of occult steal in G1-3 were 0,43%,60%,respectively.Average ages of three group were 68 years,68 years,78 years,60 years,respectively.The average reverse peak velocity of G3 was 48 cm/s,which was higher sig⁃nificantly than that of G1 and G2(48 cm/s vs 9 cm/s;Z=—2.219,P=0.026).The area under the curve(AUC)of the reverse peak velocity diagnosing G3 was 0.829.When cut off value was 18cm/s,the sensitivity and specificity were 76.5%and 80%,respectively for diagnosing G3.Conclusion The stenosis of the left subclavian artery is the most common reason for vertebral artery steal spectrum.When vertebral artery steal spectrum is occult type,the lesion is on the right,the patient is female,and the age is older than 70 years old,it is necessary to consider the possibility of fine vertebral artery or vertebral artery with stenosis,or simple vertebral artery steal.The reverse peak velocity of vertebral artery on the affected side is helpful to diagnosing simple vertebral artery steal.
作者
谢萍
石逸秋
沈雨雯
惠品晶
刘可夫
XIE Ping;SHI Yiqiu;SHEN Yufei;HUI Pinjing;LIU Kefu(The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215008,China;The Affiliated First Hospital of Soochow University,Suzhou 215008,China)
出处
《中国实用神经疾病杂志》
2023年第2期180-185,共6页
Chinese Journal of Practical Nervous Diseases
基金
姑苏卫生重点人才科研项目(编号:GSWS2019020)
南京医科大学姑苏学院课题(编号:GSKY20210209)。
关键词
经颅多普勒超声
椎动脉盗血
锁骨下动脉狭窄
椎动脉狭窄
血流频谱
反向峰值流速
CT血管成像
磁共振血管成像
Transcranial Doppler
Vertebral artery steal spectrum
Subclavian artery stenosis
Vertebral artery stenosis
Blood flow spectrum
Reverse peak velocity
CT angiography
Magnetic resonance angiography
