大脑中动脉重度狭窄进程的血流动力学研究

目的探讨大脑中动脉（MCA）重度狭窄的转归与脑血管事件再发的相关性。方法2005年1月至2013年4月在首都医科大学宣武医院选择经颅多普勒超声（TCD）筛查并经CT血管成像（CTA）或数字减影血管造影（DSA）证实的单侧MCA重度狭窄的患者133例,均应用TCD随访≥24个月。所有患者根据MCA血流动力学参数变化分为进展组43例,非进展组90例。记录并分析MCA及其毗邻动脉血流动力学参数变化、随访期间脑血管事件再发率及其与MCA狭窄进程的关系。结果 （1）2组患者首诊及随访期6-11个月、12-23个月、24-36个月内MCA狭窄远段血管搏动指数进展组（0.66±0.10、0.65±0.11、0.67±0.10、0.61±0.15）低于非进展组（0.70±0.13、0.71±0.14、0.73±0.13、0.74±0.15）,2组比较差异有统计学意义（t=-2.096、-2.089、-2.577、-2.718,P均〈0.05）。（2）24-36个月时患侧大脑前、后动脉的均值流速进展组（90.69±30.0）cm/s、（62.79±31.31）cm/s]高于非进展组（79.20±29.48）cm/s、（48.62±17.77）cm/s],2组间差异有统计学意义（t=2.091、3.324,P均〈0.05）。（3）24-36月时脑膜支开放率进展组72%（31/43）]高于非进展组41%（37/90）],差异有统计学意义（χ^2=11.178,P=0.001）。（4）随访期间短暂性脑缺血发作（TIA）和卒中再发率进展组高于非进展组28%（12/43）比7%（6/90）,33%（14/43）比2%（2/90）],差异均有统计学意义（χ^2=11.218、25.303,P均〈0.01）。（5）多元Logistic回归分析表明,随访过程中脑膜支的开放（比值比：9.649,95%可信区间：2.320-41.248）、脑血管事件再发（比值比：10.648,95%可信区间：2.530-41.261）均与MCA狭窄程度的进展密切相关。结论定期TCD随访检查可用于评价MCA重度狭窄的转归,评估侧支循环的建立,对脑血管事件再发具有预测意义。

Relationships of hemodynamic parameters and recurrent cerebral vascular events with progression of severe stenosis of the middle cerebral artery

Objective To investigate the relationships of hemodynamic parameters and recurrent cerebral vascular events with the progression of severe stenosis of the middle cerebral artery（MCA）.Methods One hundred and thirty-three patients in Xuanwu Hospital of Capital Medical University during 2005 January to 2013 April.Based on the variation of MCA hemodynamic parameters,133 patients with severe stenosis of unilateral MCA screened by transcranial Doppler ultrasonography（TCD） and confirmed by computed tomography angiography（CTA） and digital subtraction angiography（DSA） were divided into either a progression group（n=43） or a non-progression group（n=90）.The patients were followed by TCD for 24 months or more.The changes in hemodynamic parameters of the MCA and its adjacent arteries and the rate of recurrent cerebral vascular events were recorded,and their relationships with the progression of MCA stenosis were analyzed.Results Distal pulsatility index of the MCA distal to the stenosis was significantly lower in the progression group than in the non-progression group at initial diagnosis and during 6-11,12-23 and 24-36 months（0.66±0.10 vs 0.70±0.13,0.65±0.11 vs 0.71±0.14,0.67±0.10 vs 0.73±0.13,0.61±0.15 vs 0.74±0.15,t=-2.096,-2.089,-2.577,-2.718,all P0.05）.The mean flow velocity（MFV） of the anterior cerebral artery（ACA） and posterior cerebral artery（PCA） in the affected side during 24-36 months was significantly higher in the progression group than in the non-progression group（（90.69±30.0） cm/s vs（79.20±29.48） cm/s,（62.79±31.31） cm/s vs（48.62±17.77） cm/s,t=2.091,3.324,both P〈0.05）.The rate of patency of meningeal branches of the ACA and PCA during 24-36 months was significantly higher in the progression group than in the nonprogression group（72%（31/43） vs 41%（37/90）,χ^2=11.178,P=0.001）.The rates of recurrent transient ischemic attack and stroke during the follow-up period were also significantly higher in the progression group than in the n