彩色多普勒超聲與經(jīng)顱多普勒超聲聯(lián)合應(yīng)用對無癥狀性頸內(nèi)動(dòng)脈重度狹窄或閉塞的診斷價(jià)值

王欣　孟璇　馬東梅　郭方舟

彩色多普勒超聲與經(jīng)顱多普勒超聲聯(lián)合應(yīng)用對無癥狀性頸內(nèi)動(dòng)脈重度狹窄或閉塞的診斷價(jià)值

王欣孟璇馬東梅郭方舟

目的：研究彩色多普勒超聲（CDFI）與經(jīng)顱多普勒超聲（TCD）聯(lián)合應(yīng)用對無癥狀性頸內(nèi)動(dòng)脈（ICA）重度狹窄或閉塞的診斷價(jià)值。方法：對3000例高危人群行CDFI和TCD常規(guī)檢測，其中49例（98支動(dòng)脈）確定為單側(cè)或雙側(cè)ICA重度狹窄或閉塞。通過CDFI對顱外段ICA的峰值流速（PSV）、舒張末期流速（EDV）等的檢測，TCD對顱內(nèi)Willis環(huán)動(dòng)脈的檢測，確定ICA重度狹窄或閉塞的血流動(dòng)力學(xué)改變，并經(jīng)頸腦血管造影（DSA）檢測證實(shí)；將CDFI、TCD及兩者綜合結(jié)合分別與DSA進(jìn)行對比分析。結(jié)果：DSA結(jié)果顯示ICA重度狹窄50支，閉塞16支，陰性32支。CDFI、TCD及綜合結(jié)果與DSA符合分別為87支、83支和97支；敏感性分別為89.57%、84.69%、98.13%；特異性分別為85.80%、76.11%、和100%；準(zhǔn)確率分別為87.88%、84.69%、98.98%；兩者的綜合結(jié)果明顯提高了準(zhǔn)確率（P＜0.01）。結(jié)論：CDFI和TCD聯(lián)合應(yīng)用明顯提高了無癥狀性ICA重度狹窄或閉塞診斷的準(zhǔn)確性，為臨床選擇不同的治療方案提供一種可靠安全的綜合檢測方法。

彩色多普勒超聲；經(jīng)顱多普勒超聲；DSA；頸內(nèi)動(dòng)脈重度狹窄或閉塞；無癥狀性

【Abstract】Objective：To study diagnostic value of combining Color doplex flew imaging（CDFI）and Transcranial cerebral dopple（TCD）in diagnosingseverestenosisorocclusion of internalcarotid artery（ICA）symptomless.Methods：3000 casessymptomlesshigh righ population ofsenosisorocclusion of ICAwereexamined by CDFIand TCD.49 cases（98 arteries）with unilateralorbilateralstenosisorocclusion of ICAwere detected and confirmed by digitalsubtraction angiography（DSA）.CDFIdeterminated the datasofPSV and EDV of ICA and TCD determinated the changesof the hemodynamicsof intracranialartery.The resultsofCDFI，TCD and combination of twomethod were compared by x2test.Results：TheDSA showed therewere50 stenosis16occlusion and 32normalarteriesof98 ICA.Thesum ofdetectingstenosed oroccluded ICA by CDFI.TCDand CDFIplus TCD confirmed by DSAwere87，83 and 97 arteries respectively.Thesensitivity（SEN）was89.57%，88.52% and 98.13%；specificity（SPE）was 85.8%，76.11%and 100%respectively.The overallaccuracy（OA）was 87.88%，84.69%and 98.98%respectively.The resultof combining CDFIand TCD has significantily higheraccuracy than CDFIand TCD alone（P＜0.01）.Conclusion：Combining CDFIand TCD twonon-invasivemethodmay providesahigeraccuracy in diagnosingseverestensisorocclusion of ICA symptom lessandmore choicesin clinic treatment.

【Key words】color doplex flow imaging（CDFI）；transcranical Doppler（TCD）；digital subtraction angioraphy（DSA）；severe stenosis or occlusion of internal carotid artery；symptom less

腦血管病是目前威脅人類健康的最常見的慢性病之一，其中70%～80%是缺血性腦血管病（缺血性腦卒中），其具有高致病率，高致殘率和高致死率，具有突發(fā)性；近年來流行病學(xué)調(diào)查結(jié)果顯示，其發(fā)病具有年輕化趨勢［1，2］。缺血性腦血管病的發(fā)病原因主要是顱內(nèi)或顱外血管病變所致，特別是頸內(nèi)動(dòng)脈粥樣硬化引起的血管腔狹窄或閉塞是重要因素；……