颈部血管彩色超声及磁共振血管造影术对缺血性脑血管病的诊断价值

目的评价颈部血管彩色超声及磁共振血管造影术(MRA)对缺血性脑血管病的诊断价值,并探讨颈动脉粥样硬化与缺血性脑血管病及其他危险因素的关系。方法以80例脑血栓形成患者、30例一过性缺血发作(TIA)患者为病例组,40例非心脑血管病患者为对照组,行颈动脉超声检测颈动脉粥样硬化程度,部分病例行MRA检查。结果颈动脉粥样硬化斑块发生率在脑血栓形成组、TIA组及对照组分别为59%、50%和22%。脑血栓形成组斑块发生率与对照组相比差异有统计学意义(P<0.01);软斑检出率在脑血栓形成组、TIA组及对照组分别为68%、53%和10%,脑血栓形成组软斑检出率与对照组相比差异有统计学意义(P<0.01)。脑血栓形成组内-中膜厚度(IMT)增厚与对照组相比差异有统计学意义(P<0.01)。斑块常见于颈总动脉近分叉处,且易发生在双侧颈动脉及与脑部病灶同侧的颈动脉,40例患者行颈动脉超声及MRA检查,两者对颈内动脉闭塞的吻合率为100%,轻度狭窄的吻合率为75%,中重度狭窄的吻合率为80%。Logistic回归分析确定的颈动脉粥样硬化的危险因素是高血压。结论颈部血管彩色超声对于预测缺血性脑血管病具有重要意义,应定期对高危人群进行颈部血管彩色超声检查,因MRA检查费用高而无法成为常规检查项目。

Research on the diagnostic values of carotid duple a ultrasound and MRA in patients with ischemic cerebrovascular disease

Objective To evaluate the diagnostic values of carotid duples ultrasound and MRA in patients with ischemic cerebralvascular disease and to evaluate whether carotid atherosclerosis is related to cerebrovascular disease.Methods We studied 80 cases of cerebral thrombosis,30 cases of transient ischemic attack and 40 controls.Carotid atherosclerosis was assessed by duplex ultrasound.40 cases of cerebral thrombosis were examined with MRA.Comparison analysis were performed by using a SPSS 11.5 statistical packaged.Results The prevalence of carotid atherosclerosis in C1 group,TIA group and controls were 59%,50% and 22%,respectively.It is significantly higher in C1 group than controls(P<0.01).IMT was significantly higher in C1 group versus controls(P<0.01).The detection rate of blet in C1 group TIA group and controls were 68%,53% and 10%,respectively.It is significantly higher in C1 group than controls(P<0.01).Plaques is the most common near the bilateral plaques or ipsilateral plaques to the ischemic event.Carotid duplex ultrasound has high coincidence rate with MRA in diagnosis of internal carotid arterial occlusion(100%).The coincidence rate of mild and severe arterial stenosis diagnoses by carotid duplex ultrasound and MRA were 75% and 80%,respectively.Logistic regression analysis identified 1 significant variable that accounted for the carotid atherosclerosis.That was hypertension.Conclusion The baseline degree of carotid artery stenosis on carotid duplex ultrasound was the most significant predictor of future ischemic cerebralvascular disease.Routine screening with duplex ultrasound in high-risk patient population is justified and costeffective,as MRA's high cost precludes its using as a screening modality.