白质疏松症的血流动力学研究

目的研究脑白质疏松症（LA）的血流动力学变化。方法依据头颅MRI检查,将入组病人分为LA组106例及非LA组136例,并对两组病人一般为危险因素进行匹配,Fazkas量表分析将LA分为轻、中、重度,半定量分析LA患者FLAIR序列双侧白质高信号容积,重侧与轻侧比率〉1.5标准差定为不对称,所有入组病人行经颅多普勒超声（TCD）检查,记录双侧大脑中动脉（MCA）、大脑前动脉（ACA）、颈内动脉（ICA）、大脑后动脉（PCA）、椎动脉（VA）及基底动脉（BSA）的平均血流速度（Vm）及搏动指数（PI）。结果白质疏松患者相较于非白质疏松患者MCAI、CA、ACA的Vm普遍减慢,PI增高;轻度、中度及重度LA患者的MCAI、CA、ACA的Vm及PI相比差异具有统计学意义（P〈0.05）,随着LA程度的增加,Vm逐渐减慢,PI逐渐增高。不对称白质疏松重侧MCA、ICA、ACA的Vm较轻侧减慢,PCA、VA的Vm重侧与轻侧相比差异无统计学意义（P〉0.05）,不对称LA的重侧PI较轻侧增高。结论白质区域主要由颈内系统供血,LA患者脑血流速度普遍下降,脑血流灌注普遍降低,脑血流阻力增高;随着LA程度增加,脑灌注逐渐降低。LA患者存在慢性缺血缺氧状态。

Study on cerebral blooding flow in patients with leukoaraiosis

Objective To observe the changes of the cerebral blooding flow in the patients with leucoaraiosis.Methods Based on brain magnetic resonace imaging diagnosis,all the patients were divided into LA group（n=106） and non-LA group（n=136）,the risk factors for both groups were generally matched,Fazkas LA scale analysis will used to divided LA group into mild,moderate and severe level.FLAIR scans were used to analysis of the volume of white matter hyperintensities（WMH）,according to a modified semi-automated quantification method.Leukoaraiosis patients with a ratio of WMH volumes in heavy WMH side and WMH volumes in light WMH side 1.5 were considered as asymmetric WMH.All the patients have taken a Transcranial Doppler（TCD） examination,recording the average flow velocity（Vm） and pulse index（PI） of the middle cerebral artery（MCA）,anterior cerebral artery（ACA）,internal carotid artery（ICA）,posterior cerebral artery（PCA）,vertebral artery（VA） and basilar artery（BSA）.Results Compared with non-LA,all the artery blood flow velocity in the brain of LA was slower,but PI were higher.With the degree increased of LA,Vm generally slowed down,PI increased.In the heavy side asymmetric leukoaraiosis,Vm of MCA,ICA,ACA were slower than in the light side,but the Vm of PCA and VA has no statistic significance in the both sides（P0.05）,but the PI of all the artery were increased in the both side.Conclusion The cerebral flow of the entire brain artery general declined,cerebral vascular resistance increased;With the LA degree increased,cerebral perfusion decreased.The patients with LA were in the chronic ischemia and hypoxia.