周盼妍 谢培凯 张恒 何景雄

【摘要】 目的：探究腦颈血管超声一体化检查在评估椎动脉颅内段闭塞与发育不良中的价值。方法：回顾性分析2019年1月-2020年6月本院住院的50例患者的资料设为研究组，根据数字减影血管造影（digital subtraction angiography， DSA）检查结果将研究组患者分成椎动脉发育不良组（n=28）与颅内段闭塞组（n=22）。并选取同期30例脑血管DSA阴性者为对照组。采用彩色多普勒血流显像（color Doppler flow imagin， CDFI）和经颅彩色多普勒（transcranial color code sonography， TCCS）联合检查方法，分析椎动脉椎间隙段及颅内段血流动力学改变。结果：三组椎动脉椎间隙段健侧Vs及Vd比较，差异均无统计学意义（P>0.05）;三组椎动脉椎间隙段健侧RI和患侧Vs、Vd、RI比较，差异均有统计学意义（P<0.05）。颅内段闭塞组患侧Vs及Vd最低，RI最高。三组颅内段椎动脉健侧及患侧的Vs、Vd、PI比较，差异均有统计学意义（P<0.05）。三组间以颅内段闭塞组患侧Vs及Vd最低，健侧Vs及Vd最高。脑颈血管超声诊断敏感度为90.9%，特异度为78.6%，假阳性率为21.4%，假阴性率为9.1%，准确度为84.0%，阳性预测值为0.769，阴性预测值为0.917，阳性似然比为4.248，阴性似然比为0.116，约登指数为0.695。结论：脑颈血管超声一体化检查可以完整观察椎动脉全程血流信号，系统分析椎动脉血流动力学变化，在评估椎动脉颅内段闭塞与发育不良具有一定应用价值。

【关键词】 脑颈血管超声一体化检查 椎动脉颅内段闭塞 椎动脉发育不良 经颅彩色多普勒超声

[Abstract] Objective： To explore the value of integrated cerebral cervical vascular ultrasound in the evaluation of intracranial segment occlusion and dysplasia of vertebral artery. Method： The data of 50 patients admitted to our hospital from January 2019 to June 2020 were retrospectively analyzed， selected as the study group. According to the results of digital subtraction angiography （DSA）， the patients in the study group were divided into vertebral artery dysplasia group （n=28） and intracranial segment occlusion group （n=22）， thirty cerebrovascular DSA negative patients were selected as the control group. Combined color Doppler flow imagin （CDFI） and transcranial color code sonography （TCCS） were used. The hemodynamic changes of vertebral artery intervertebral segment and intracranial segment were analyzed. Result： There were no significant differences in Vs and Vd among the three groups （P>0.05）. The RI of the healthy side and the Vs， Vd， RI of the affected side were compared among the three groups， the differences were statistically significant （P<0.05）. In the intracranial segment occlusion group， Vs and Vd were the lowest and RI was the highest. Comparison of Vs， Vd and PI between the healthy side and the affected side of intracranial vertebral artery in three groups， the differences were statistically significant （P<0.05）. Among the three groups， the Vs and Vd of the affected side were the lowest in the intracranial segment occlusion group， and the Vs and Vd of the contralateral side were the highest. The sensitivity， specificity， false positive rate， false negative rate， accuracy， positive predictive value， negative predictive value， positive likelihood ratio， negative likelihood ratio and Youden index were 90.9%， 78.6%， 21.4%， 9.1%， 84.0%， 0.769， 0.917， 4.248， 0.116 and 0.695， respectively. Conclusion： The integrated examination of cerebral and cervical vascular ultrasound can completely observe the whole blood flow signal of vertebral artery and systematically analyze the hemodynamic changes of vertebral artery， which has a certain application value in the evaluation of vertebral artery intracranial occlusion and dysplasia.

[Key words] Integrated ultrasound examination of cerebral and cervical vessels Vertebral artery intracranial segment occlusion Vertebral artery dysplasia Transcranial color code sonography

First-author’s address： Zhuhai People’s Hospital （Zhuhai Hospital Affiliated with Jinan University）， Zhuhai 519000， China

doi：10.3969/j.issn.1674-4985.2021.17.032

根据相关资料显示，我国卒中发生率约为39.9%，位居全球首位。卒中是我国成人致死、致残的第一病因[1]。后循环卒中占全部缺血性卒中的20%～30%，椎动脉颅内段闭塞是后循环缺血的重要原因[2]，患者致残率高达18%，死亡率高达25%[3]。……