经颅多普勒超声评价大脑中动脉慢性闭塞患者颅内侧支循环的血流动力学改变

目的探计经颅多普勒超声（TCD）评价大脑中动脉（MCA）慢性闭塞患者颅内侧支循环血流动力学特点的可行性。方法连续纳入2008年9月-2010年2月，在首都医科大学宣武医院神经内、外科就诊并经DSA确诊的单侧MCA闭塞的患者共140例。根据DSA显示的软脑膜支代偿情况，分为无代偿组21例、单纯大脑前动脉（ACA）代偿组43例、单纯大脑后动脉（PCA）代偿组28例及ACA＋PCA共同代偿组48例。采用TCD检测患者双侧MCA、ACA、PCA的收缩期峰值流速（PSV）。计算患侧（d）ACA与健侧（n）MCA的PSV比值（dPSVACA／nPSVMCA），患侧ACA与健侧ACA的PSV比值（dPSVACA／nPSVACA）及患侧PCA与健侧PCA的PSV比值（dPSVPCA／nPSVPCA）。比较各组间血流动力学的参数指标。结果①单纯ACA代偿组及ACA＋PCA代偿组的dPSVACA／nPSVMCA分别为1．35±0．33和1．34±0．36，显著高于无代偿组和单纯PCA代偿组，P〈0．01。②单纯ACA代偿绀及ACA＋PCA代偿组的dPSVACA／nPSVACA分别为1．67±0．76和1．62±0．44，显著高于无代偿组和单纯PCA代偿组，P〈0．01。③单纯PCA代偿组及ACA＋PCA代偿组的dPSVPCA／nPSVPCA分别为1．76±0．56和1．73±0．49，显著高于无代偿组和单纯ACA代偿组，P〈0．01。结论TCD检食显示的ACA、PCA血流动学改变，可以间接反映MCA闭塞患者软脑膜支的代偿情况。

Evaluation of intracranial collateral circulation in patients with chronic middle cerebral artery occlusion with transcranial color Doppler ultrasonography

Objectives To investigate the value of intracranial collateral circulation in patients with chronic middle cerebral artery （MCA） occlusion with transcranial color Doppler ultrasonography （TCD） and to establish the indicators of hemodynamic parameter and assess their accuracy. Methods A total of 140 consecutive patients with unilateral MCA occlusion diagnosed by digital subtraction angiography （DSA） in the Departments of Neurology and Neurosurgery, Xuan Wu ltospital, Capital Medical University, Beijing, China were included from September 2008 to February 2010. According to the leptomeningeal branch compensation showed on DSA, the patients were divided into no compensation （n = 21 ） , simple anterior cerebral artery （ ACA ） compensation （ n = 43 ）, simple posterior cerebral artery （ PCA ） compensation （ n = 28）, and ACA ＋ PCA compensation （n = 48） groups. TCD was used to detect the peak systolic velocity （PSV） of bilateral MCA, anterior cerebral artery （ ACA）, and posterior cerebral artery （PCA）. The ratios of ACA peak velocity on the ipsilateral side （d） and MCA peak velocity on the contralateral side （n） （ dPSVACA/nPSVMCA ） , the ratios of ACA peak velocity on the ipsilateral side and ACA peak velocity on the contralateral side （dPSVACA/nPSVACA） , as well as the ratios of PCA peak velocity on the ipsilateral side and PCA peak velocity on the contralateral side （dPSVPCA/nPSVPCA） were calculated. Taking ACA and PCA leptomeningeal branches open or not showed on DSA as a reference standard, tile ROC curve was used to establish the optimal boundary values of hemodynamic parameters for evaluating ACA and PCA in participation of compensation, and the sensitivity, specificity, and accuracy were assessed. Results ①The dPSVACA/nPSVMCA in the simple ACA compensation and ACA ＋ PCA compensation groups were 1. 341 ± 0. 348 and 1. 337 ±0. 403 respectively, which were significantly higher than 0. 883 ±0. 256 in the no ACA compensation group. The dPSVAXA/nPSVACA in the simple ACA compensation and ACA ＋ PCA compensation groups were 1. 660 ±0. 753 and 1. 670±0. 404 respectively, which were significantly bigher than 0. 978 ±0. 259 in the no ACA compensation group. The dPSVPCA/nPSVPCA in the simple PCA compensation and ACA ＋ PCA compensation groups were 1. 758 ±0. 560 and 1. 735 ±0. 486 respectively, which were significantly higher than 1. 210 ±0. 336 in the nu PCA compensation group. ② The dPSVACA/nPSVNCA≥ 1.20 and dPSVACA/nPSVACA ≥ 1. 25 were nsed as the optimal cutoff values of ACA compensation, and their accuracy were 65.7% and 78.5% respectively. The dPSVPCA/nPSVPCA ≥1.45 were used as the optimal cutoff values of PCA compensation, and its accuracy was 75.0%. Conclusions TCD can be used as an examination method for evaluating ACA and PCA leptomeningeal branch compensation ability in patients with MCA occlusion. Establishment of TCD hemodynamic parameters has important clinical value fur accurately assessing the status and prognosis of collateral circulation in patients with MCA occlusion.