经颅多普勒超声参数联合屏气指数对ICA狭窄或闭塞所致急性脑梗死的评估价值

doi:10.20223/j.cnki.1000-8535.2025.12.015

摘要/Abstract

摘要： 目的探讨经颅多普勒超声（TCD）参数联合屏气指数在颈内动脉（ICA）狭窄或闭塞所致急性脑梗死的评估价值。方法选择2022年1月—2024年12月,在广州市花都区人民医院连续入组发病72 h内ICA狭窄或闭塞所致的急性脑梗死患者。记录患者人口统计学资料、临床资料及TCD相关参数,包括搏动指数（PI）、阻力指数（ RI）、大脑中动脉平均血流速度（Vm）及屏气指数等。依据患者数字减影血管造影（DSA）结果分为侧支循环良好组及侧支循环不良组。比较两组人口统计学、临床资料及TCD相关参数,采用单因素分析、多因素Logistic回归分析及ROC曲线。结果共纳入ICA狭窄或闭塞所致急性脑梗死共136例,其中侧支循环良好组46例,侧支循环不良组90例。单因素分析提示：侧支循环良好组与侧支循环不良组在PI[0.95（0.80,1.03）vs 1.01（0.88,1.13）]、RI[0.58（0.51,0.62）vs 0.60（0.54,0.65）]、Vm[57（44,65）vs 50.5（41,63）]及屏气指数[0.78（0.75,0.85）vs 0.72（0.59,0.79）]方面,差异具有统计学意义（P<0.05）。多因素Logistic回归分析提示Vm（OR=1.029,95%CI：1.006~1.053,P=0.014）、屏气指数（OR=723.401,95%CI：14.524~3 6031.859,P<0.001）是侧支循环不良的独立危险因素。屏气指数和Vm评估侧支循环情况的ROC曲线下面积（AUC）分别为0.713（95%CI：0.627~0.799）和0.605（0.505~0.705）,两者的AUC值比较差异无统计学意义（P>0.05）。结论屏气指数和Vm可以评估ICA狭窄或闭塞所致急性脑梗死的侧支循环,屏气指数和Vm的评估效能相当。

关键词: 颈内动脉, 脑梗死, 屏气指数, 侧支循环

Abstract: Objective To explore the evaluation value of transcranial Doppler ultrasound（TCD）in acute cerebral infarction caused by internal carotid artery（ICA）stenosis or occlusion．Methods From January 2022 to December 2024,patients with acute cerebral infarction caused by ICA stenosis or occlusion within 72 hours of onset were enrolled in our hospital．Patient's demographic data,clinical data,and TCD related parameters,including pulsatility index（PI）,resistance index（RI）,average blood flow velocity（Vm）of the middle cerebral artery,and breath holding index（BHI）were recorded．According to the results of digital silhouette angiography（DSA）,patients were divided into good collateral group and poor collateral group．Demographic,clinical data,and TCD related parameters were compared between two groups using univariate analysis,multivariate Logistic regression analysis and ROC curve．Results A total of 136 cases of acute cerebral infarction caused by ICA stenosis or occlusion were included,including 46 cases in the collateral good group and 90 cases in the collateral poor group．Univariate analysis showed that the good collateral group and the poor collateral group were different in PI（0.95[0.80,1.03]vs 1.01[0.88,1.13]）,RI（0.58[0.51,0.62]vs 0.60[0.54,0.65]）,Vm（57[44,65]vs 50.5[41,63]）,BHI（0.78[0.75,0.85] vs 0.72[0.59,0.79]）（P<0.05）．Multivariate Logistic regression analysis showed that Vm（OR=1.029,95%CI：1.006-1.053,P=0.014）and BHI（OR=723.401,95%CI：14.524-36 031.859,P<0.001）were independent risk factors for collateral circulation disorders．The area under the ROC curve（AUC）for predicting collateral circulation using BHI and Vm were 0.713（95%CI：0.627~0.799）and 0.605（0.505~0.705）,respectively．There was no statistically significant difference in AUC values between the BHI and Vm．Conclusions The BHI and Vm can predict the collateral circulation of acute cerebral infarction caused by ICA stenosis or occlusion,and their predictive power is comparable．

Key words: internal carotid artery, cerebral infarction, breath holding index, collateral circulation

蔡惠霞, 利伟江, 周雍庭, 幸享凤, 刘湘敏. 经颅多普勒超声参数联合屏气指数对ICA狭窄或闭塞所致急性脑梗死的评估价值[J]. 广州医药, 2025, 56(12): 1724-1729.

CAI Huixia, LI Weijiang, ZHOU Yongting, XING Xiangfeng, LIU Xiangmin. The evaluation value of transcranial Doppler ultrasound parameters combined with breath holding index for acute cerebral infarction caused by ICA stenosis or occlusion[J]. Guangzhou Medical Journal, 2025, 56(12): 1724-1729.

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