脑部狭窄动脉患者血流参数与老年脑梗死发生的相关性研究

摘要

目的 探讨血管狭窄患者血流动力学参数和血压与老年脑梗死发生的相关性. 方法 回顾性研究,将262例由于脑部血管狭窄引起短暂性脑缺血发作(TIA)的老年患者按照是否发生脑梗死分为脑梗死组124例和非脑梗死组138例,比较两组责任脑动脉的血流动力学参数和血压差异,并分析其与脑梗死发生的相关性;受试者工作特征(ROC)曲线分析不同程度血管狭窄时,各血流参数对于脑梗死发生的特异性、敏感性及其诊断界限值. 结果 在控制相关因素影响的情况下,脑梗死的发生与血流动力学参数收缩期峰值速度(Vs)、舒张末期速度(Vd)、平均血流速度(Vm)呈负相关,与舒张压呈正相关(r值分别为0.445、-0.420、-0.459、0.292,均P＜0.01);轻度、中度及重度血管狭窄时脑梗死发生的风险标准分别为Vs≤97.1 cm/s、≤185.8 cm/s、≤198.6cm/s;Vd≤43.4 cm/s、Vd≤83.6 cm/s、Vd≤121.1 cm/s;Vm≤59.9 cm/s、≤123.7 cm/s、≤137.5cm/s;舒张压＞92.3 mmHg(1 mmHg=0.133 kPa)、＞104.5 mmHg、＞109.6 mmHg. 结论 血流参数和老年脑梗死发生相关;脑动脉血管狭窄程度相同时,Vm越低、舒张压越高发生脑梗死的风险越高.%Objective To evaluate the correlation of hemodynamic parameters and blood pressure with cerebral infarction in elderly patients with stenosis.Methods 216 elderly patients with transient ischemic attack(TIA)caused by cerebral stenosis were collected and divided into the cerebral infarction group and the control group.Differences in hemodynamic parameters and blood pressure between the two groups and the correlation between the parameters and cerebral infarction were analyzed.Receiver operating characteristic(ROC)curves were used to analyze the specificity,sensitivity and threshold of each parameter under different degrees of stenosis.Results After adjusting for the well-known associated factors,the occurrence of cerebral infarction was negatively correlated with systolic peak velocity(Vs),end diastolic velocity(Vd) and mean blood flow velocity(Vm),and positively correlated with diastolic blood pressure(r=-0.445 、-0.420 、-0.459、0.292,P＜ 0.01).In addition,the risk thresholds for cerebral infarction under mild,moderate and severe vascular stenosis were Vs≤97.1,Vd≤43.4,Vm≤59.9 cm/s,and diastolic blood pressure ＞92.3 mmHg(1 mmHg=0.133 kPa);Vs≤ 185.8,Vd≤ 83.6,Vm≤ 123.7 cm/s,and diastolic blood pressure ＞ 104.5 mmHg;Vs≤ 198.6,Vd≤ 121.1,Vm ≤ 137.5 cm/s,and diastolic blood pressure ＞ 109.6 mmHg,respectively.Conclusions There is a correlation between the blood flow parameters and elderly cerebral infarction.Based on the degree of cerebral arterial stenosis,the risk of cerebral infarction occurrence is greater with decreased blood flow velocity and increased diastolic blood pressure.