慢型克山病患者脑血流动力学观察

目的 观察慢型克山病患者脑血流动力学改变,为临床诊断及治疗提供依据.方法 慢型克山病患者根据心脏X线检测结果分为2组,心脏中度增大组39例,心胸比例为0.55～0.60,心脏重度增大组47例,心胸比例0.60.另选择35例体检健康者作为对照组.利用经颅多普勒(TCD)检测大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)、基底动脉(BA)及椎动脉(VA)的平均血流速度(Vm)、搏动指数(PI)和阻力指数(RI).结果 ①Vm:心脏中、重度增大组MCA[(57.4±8.9)、(55.1±7.9)cm/s]、ACA[(41.6±8.5)、(39.5±8.1)cm/s]、VA[(35.6±7.8)、(33.5±7.6)cm/s]均明显低于对照组[(63.2±11.6)、(47.3±10.9)、(39.7±9.5)cm/s],两组比较差异均有统计学意义(P<0.05),且心脏重度增大组PCA[(31.2±8.3)cm/s]、BA[(38.7±7.9)cm/s]也明显低于对照组[(38.1±10.5)、(45.3±11.7)cm/s],两组比较差异有统计学意义(P<0.05).②PI:心脏中、重度增大组MCA(0.92±0.12、1.01±0.13)、ACA(0.90±0.14、0.94±0.15)、PCA(0.89±0.15、0.92±0.14)BA(0.93±0.13、0.96±0.15)、VA(0.91±0.14、0.93±0.16)与对照组(0.74±0.10、0.77±0.15、0.72±0.13、0.68±0.12、0.69±0.14)比较均明显增高(P<0.05),心脏重度增大组明显高于中度增大组(P<0.05).③RI:心脏中、重度增大组ACA(0.63±0.06、0.70±0.07)、PCA(0.62±0.07、0.65±0.08)、BA(0.66±0.09、0.68±0.10)、VA(0.63±0.08、0.64±0.09)与对照组(0.52±0.07、0.54±0.08、0.56±0.07、0.57±0.06)比较明显增高(P<0.05),心脏重度增大组明显高于中度增大组(P<0.05);而心脏重度增大组MCA(0.67±0.09)与对照组(0.53±0.06)和中度增大组(0.65±0.07)比较均明显增高(P<0.05).结论 慢型克山病可引起患者脑血流动力学改变,并且随着病情加重.患者脑血流供应障碍更为明显.TCD检测慢型克山病患者脑血流改变简便易行、无创伤、重复性好,对脑血流改变能定量评价、准确可靠,对慢型克山病患者病情判断、临床治疗、转归及愈后有参考意义.

Observation on cerebral artery kinetics in patients with chronic Keshan disease

Objective To observe changes of eerebral blood flow kinetics in chronic Keshan disease patients to facilitate the clinical diagnosis and treatment. Methods The patients were divided into two groups according to the X-ray examination: 39 patients with a moderately enlarged heart in a eardiothoraeic ratio of 0.55～ 0.60 and 47 patients with a markedly enlarged heart in a cardiothoraeic ratio 0.60. Another group of 35 healthy individuals was included as controls. Cerebral arteries mean velocity (Vm), pulsatility index (PI), and resistance index(RI) of middle cerebral artery(MCA), anterior cerebral artery(ACA), posterior cerebral artery(PCA), basilar artery(BA), and vertebral artery(VA) were determined with transcranial Doppler(TCD) to observe. Results ①Vm of MCA being(57.4±8.9), (55.1±7.9)cm/s, ACA being(41.6±8.5), (39.5±8.1)cm/s, VA being(35.6±7.8), (33.5±7.6)em/s in the groups of individuals with a moderately or markedly enlarged heart were significantly decreased eompared with those of the control group, the latter being(63.2±11.6),(47.3±10.9),(39.7±9.5) era/s, with statical signifieances(P<0.05). PCA[(31.2±8.3)cm/s], BA[(38.7±7.9)cm/s] in the group of markedly enlarged heart also significantly were decreased, compared with those of the control group[ (38.1±10.5), (45.3±11.7)cm/s] ,and the difference being statically signifieant(P<0.05). ②As for PI, MCA(0.92±0.12, 1.01±0.13), ACA(0.90±0.14,0.94±0.15), PEA(0.89±0.15,0.92±0.14), BA(0.93±0.13,0.96±0.15), VA(0.91±0.14, 0.93±0.16) in the groups of individuals with a moderately or markedly enlarged heart significantly were increased, respectively compared with those of the control group(0.74±0.10,0.77±0.15,0.72±0.13,0.68± 0.12,0.69±0.14) with statical significances(P<0.05). Moreover, the increase was more pronounced in the markedly enlarged heart group than the moderately enlarged group(P<0.05). ③RI with ACA(0.63±0.06,0.70± 0.07), PCA(0.62±0.07,0.65±0.08), BA(0.66±0.09,0.68±0.10) and VA(0.63±0.08,0.64±0.09) in the groups with a moderately or markedly enlarged heart were significantly increased, compared with those of the control group(0.52±0.07,0.54±0.08,0.56±0.07,0.57±0.06) respectively with statical significances(P<0.05). Moreover, the increase was more pronounced in the heart markedly enlarged group than in the moderately enlarged heart group(P<0.05). MCA(0.67±0.09) in the groups of individuals with a markedly enlarged heart significantly increased, compared with those of the control group(0.53±0.06) and in the groups of individuals with a moderately enlarged heart(0.65±0.07), the difference had statical significances(P<0.05). Conclusions The chronic Keshan disease patients exhibits cerebral blood flow kinetic changes. In some serious cases, the cerebral blood flow changes more obviously. TCD has proven to be a simple, accurate and reliable method to detect cerebral blood flow kinetics changes in chronic Keshan disease patients, thus can be a help in the diagnosis and treatment of chronic Keshan disease.