单侧MCA重度狭窄或闭塞患者的颅内血流动力学与侧支循环的TCD探讨

目的:探讨TCD对MCA重度狭窄或闭塞患者的软脑膜侧支循环开放的诊断标准。方法:将48例MCA重度狭窄或闭塞患者DSA的结果比较TCD判断ACA、PCA的软脑膜侧支(LM-Cs)开放的两种方法的特异性与敏感性;对LMCs开放与脑血管病的主要危险因素进行统计学分析。结果:TCD以iVACA>cVMCA为标准判断ACA侧支的敏感性90.5%,特异性70.4%,YI=0.61,ROCAUC为0.79;以iVACA>1.3cVACA为判断ACA侧支开放的标准敏感性为70%,特异性为63.0%,YI=0.33,ROCAUC为0.70,尚无统计学意义(u=0.75,P>0.05)。TCD以iVPCA>cVMCA为标准判断PCA侧支的敏感性45.5%,特异性84.6%,YI=0.30,ROCAUC为0.67;以iVPCA>1.3cVPCA为判断ACA侧支开放的标准,敏感性77.3%,特异性69.2%,YI=0.47,ROCAUC为0.74,尚无统计学意义(u=0.92,P>0.05)。无论是单因素Logistic回归分析还是多因素非条件Logistic回归分析均未发现各项危险因素与LMCs开放有关。结论:TCD能间接判断MCA病变后的LMCs开放情况,以iVACA>cVMCA,iVPCA>1.3cVPCA为评判相应LMCs开放标准的敏感性、特异性、YI值及ROCAUC可能优于iVACA>1.3cVACA,iVPCA>cVMCA。

Study of TCD on the Collateral Circulation in Patients with Severe Stenosis or Occlusion of Unilateral Middle Cerebral Artery

Objective To explore the diagnostic standard of leptomeningeal collateral channels （LMCs） opening in patients with severe stenosis or occlusion of MCA by TCD. Methods According to DSA results （got by Philips Allura Xper FD20）, compare the specificity and sensitivity of two standards in LMCs opening of ACA and PCA in 48 patients with severe stenosis or occlusion of MCA. Results The sensitivity and specificity of LMCs of ACA judged by iVACA 〉 CVMCA with TCD were 90.5% and 70.4%, respectively. YI = 0.61, ROCAUC = 0.79; judged by iVACA 〉 1.3CVACA were 70.0 % and 63.0 %, respectively. YI = 0.33, ROCAUC = 0.70. There was no statistical significance （u = 0.75, P 〉 0.05）. The sensitivity and sensitivity of LMCs of PCA judged by iVPCA 〉 1.3cVPCA with TCD were 77.3% and 69.2%, respectively. YI = 0.47, ROCAUC = 0.74; judged by iVPCA 〉 cVMCA with TCD were 45.5% and 84.6%, respectively. YI = 0.30, ROCAUC= 0.67. There was no statistical significance （ u = 0.92, P 〉 0.05）. Neither univariate logistic regression analysis nor multivfariate logistic regression analysis found the relationship between risk factors and collateral circulation opening. Conclusions The situation of opening of the collateral branches of MCA after disease can be judged indirectly with TCD. The sensitivity and specificity of standard, YI value and ROC AUC of the opening of the collateral branches judged by iVACA〉 cVMCA, iVPCA 〉 1.3cVPCA are superior to those by iVACA 〉 1.3cVACA, iVPCA 〉 cVMCA. However, there is no statistical significance.