经颅多普勒脑血流动力学参数在颅内结核诊治中的应用价值评估

目的 通过分析颅内结核患者的经颅多普勒(transcranial doppler,TCD)脑血流动力学参数,探讨其动力学变化特点及其与颅内压(intracranial pressure,ICP)的相关性,分析TCD在颅脑结核诊治中的价值。 方法 连续纳入2016年3-9月浙江省中西医结合医院收治的颅内结核患者52例作为病例组,另取3例健康体检者作为健康对照组。对52例颅内结核患者在腰穿术前一天行TCD检查,获取基底动脉(basilar artery,BA)、椎动脉(vertebral artery,VA)、大脑后动脉(posterior cerebral artery,PCA)及大脑中动脉(middle cerebral artery,MCA)和大脑前动脉(anterior cerebral artery,ACA)的流速峰值(spectral atlas systolic peak velocity,Vs)、流速均值(mean velocity,Vm)、舒张末期流速(end diastolic velocity,Vd)、搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)等指标。统计分析以上数据及腰穿术所得ICP。 结果 颅内结核组MCA和ACA流速较正常对照组下降,BA、VA和PCA流速较正常对照组明显下降,所测动脉PI值均升高。相关分析结果提示PI值与ICP呈正相关。 结论 颅内结核异常改变波及整个颅内动脉系统。MCA及ACA流速较快,与ICP和PI均增高有关,且流速越快则可能提示病情越重,预后越差。后循环流速减慢可能和患者颅底结核渗出物沉积有关。 

Role of cerebral hemodynamic parameters by transcranial Doppler in diagnosis and treatment of intracranial tuberculosis

Objective To study the transcranial Doppler (TCD) -derived cerebral hemodynamic parameters in patients with intracranial tuberculosis, explore the characteristics of cerebral blood flow dynamics and its correlation with intracranial pressure (ICP), and evaluate the role of TCD in the diagnosis and treatment of intracranial tuberculosis. Methods The TCD were performed beside beds one day before the lumbar puncture for pressure testing in 52 patients with intracranial tuberculosis in our hospital between March, 2016 and September, 2016. The spectral atlas systolic peak velocity (Vs), mean velocity (Vm) and end of diastolic velocity (Vd), pulsatility index (PI), and resistance index (RI) of the basilar artery (BA), vertebral artery (VA), anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA) of both sides were determined. The results and ICP were analyzed statistically. Results Compared with control group, the blood flow velocity of anterior cerebral artery (ACA) and middle cerebral artery (MCA) by TCD in patients with intracranial tuberculosis decreased, the blood flow velocity of basilar artery (BA), vertebral artery (VA) and posterior cerebral artery (PCA) were significant decreased, while the pulsatility index (PI) increased. The result of correlation analysis was positive between PI and ICP. Conclusion All internal carotid artery and vertebral basilar artery system were involved in the abnormal changes caused by intracranial tuberculosis. The blood flow velocity of anterior cerebral artery (ACA) and middle cerebral artery (MCA) is faster relatively, which is associated with increased intracranial pressure and PI, and the faster the flow velocity, could demonstrate the more serious the condition, and the worse prognosis. The blood flow velocity of basilar artery and vertebral artery slows down may associate with TB exudate of base of Skull.