颈部动脉夹层管腔不全再通的影响因素分析

目的通过彩色多普勒血流显像（CDFI）评估随访颈部动脉夹层（CAD）血管结构及血流动力学变化，进而从多个层面分析CAD管腔不全再通的影响因素。 方法连续性纳入2014年1月至2018年12月于首都医科大学宣武医院诊断为壁内血肿型CAD的患者105例（126支病变血管）。所有患者于发病后第3、6、12个月行CDFI随访检查，依据CDFI检查结果将其分为完全再通与不全再通2组，分析患者年龄、脑血管病危险因素、动脉狭窄程度、药物治疗等因素对CAD再通性的影响。 结果126支夹层血管中，不全再通组共54支（42.9%）。多因素Logistic回归分析显示，患者年龄>45岁（OR=3.594，95%CI：1.430~9.033，P=0.007）、有高血压病史（OR=3.037，95%CI：1.079~8.544，P=0.035）、就诊距发病时间>30 d（OR=3.135，95%CI：1.122~8.759，P=0.029）、血管闭塞（OR=7.381，95%CI：2.620~20.795，P=0.000）均是CAD不全再通的独立危险因素。而CAD的发病原因、壁内血肿累及范围、抗凝或抗血小板治疗方式等不是影响CAD管腔再通的因素（P均>0.05）。 结论应用CDFI诊断并及时随访CAD患者，并结合年龄、高血压病史、治疗时机、动脉管腔的狭窄程度等影响因素进行综合分析，对评估CAD患者的预后再通具有重要的临床意义。

Ultrasonographic evaluation of factors leading to incomplete recanalization of cervical artery dissection

ObjectiveTo analyze the influencing factors leading to incomplete recanalization of cervical artery dissection (CAD) by color Doppler flow imaging (CDFI). MethodsA total of 105 patients with 126 CADs diagnosed at XuanWu Hospital, Capital Medical University from January 2014 to December 2018 were enrolled into this study. All patients were followed by CDFI at 3, 6, and 12 months after disease onset and were divided into either a complete recanalization group or an incomplete recanalization group according to the results at 12 months after the onset. The effect of factors such as age, cerebrovascular risk factors, arterial stenosis, and drug treatment on CAD recanalization were analyzed. ResultsOf the 126 dissected vessels, 54 (42.9%) were included in the incomplete recanalization group. Logistic regression analysis showed that age>45 years (OR=3.594, 95% CI: 1.430-9.033, P=0.007), history of hypertension (OR=3.037, 95% CI: 1.079-8.544, P=0.035), time from onset to treatment over one month (OR=3.135, 95% CI: 1.122-8.759, P=0.029), vascular occlusion (OR=7.381, 95% CI: 2.620-20.795, P=0.000) were independent risk factors for CAD recanalization; however, cause of CAD, extent of intramural hematoma, and anticoagulation or antiplatelet therapy were not factors affecting the incomplete recanalization of CAD (P>0.05). ConclusionDiagnosis and timely follow-up of CAD patients by CDFI to assess the correlation between the factors such as age, history of hypertension, timing of treatment, or stenosis of arterial lumen and recanalization are of important clinical significance.