彩色多普勒超声与经颅多普勒超声联合应用对无症状性颈内动脉重度狭窄或闭塞的诊断价值

王欣　孟璇　马东梅　郭方舟

彩色多普勒超声与经颅多普勒超声联合应用对无症状性颈内动脉重度狭窄或闭塞的诊断价值

王欣孟璇马东梅郭方舟

目的：研究彩色多普勒超声（CDFI）与经颅多普勒超声（TCD）联合应用对无症状性颈内动脉（ICA）重度狭窄或闭塞的诊断价值。方法：对3000例高危人群行CDFI和TCD常规检测，其中49例（98支动脉）确定为单侧或双侧ICA重度狭窄或闭塞。通过CDFI对颅外段ICA的峰值流速（PSV）、舒张末期流速（EDV）等的检测，TCD对颅内Willis环动脉的检测，确定ICA重度狭窄或闭塞的血流动力学改变，并经颈脑血管造影（DSA）检测证实；将CDFI、TCD及两者综合结合分别与DSA进行对比分析。结果：DSA结果显示ICA重度狭窄50支，闭塞16支，阴性32支。CDFI、TCD及综合结果与DSA符合分别为87支、83支和97支；敏感性分别为89.57%、84.69%、98.13%；特异性分别为85.80%、76.11%、和100%；准确率分别为87.88%、84.69%、98.98%；两者的综合结果明显提高了准确率（P＜0.01）。结论：CDFI和TCD联合应用明显提高了无症状性ICA重度狭窄或闭塞诊断的准确性，为临床选择不同的治疗方案提供一种可靠安全的综合检测方法。

彩色多普勒超声；经颅多普勒超声；DSA；颈内动脉重度狭窄或闭塞；无症状性

【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

脑血管病是目前威胁人类健康的最常见的慢性病之一，其中70%～80%是缺血性脑血管病（缺血性脑卒中），其具有高致病率，高致残率和高致死率，具有突发性；近年来流行病学调查结果显示，其发病具有年轻化趋势［1，2］。缺血性脑血管病的发病原因主要是颅内或颅外血管病变所致，特别是颈内动脉粥样硬化引起的血管腔狭窄或闭塞是重要因素；……