【摘要】：目的：以磁共振血管成像（MRA）為診斷顱內(nèi)血管狹窄的確證方法，探討經(jīng)顱多普勒超聲（TCD）評(píng)估椎動(dòng)脈（Vertebral artery，VA）和基底動(dòng)脈（Basilar artery，BA）狹窄臨床診斷中的應(yīng)用價(jià)值。 方法：2013年7月至2014年10月在吉林大學(xué)白求恩第一醫(yī)院住院、經(jīng)TCD檢查提示椎-基底動(dòng)脈血流異常的缺血性腦血管病患者221例并于1周內(nèi)行MRA檢查的患者，比較兩種方法對(duì)椎-基底動(dòng)脈的檢測(cè)結(jié)果。依據(jù)MRA結(jié)果分為正常組與狹窄組，TCD檢測(cè)記錄各組中椎-基底動(dòng)脈的收縮期峰值流速（Peak Systolic Velocity，PSV)、舒張期流速（End Diastolic Velocity，EDV）、平均流速（Mean Flow Velaocity，MFV）、動(dòng)脈搏動(dòng)指數(shù)（PI）、頻譜形態(tài)及聲頻特征等，并對(duì)兩組檢測(cè)結(jié)果進(jìn)行對(duì)比分析。應(yīng)用Kappa值度量TCD和MRA這兩種檢查方法的一致性。 結(jié)果：共有221例患者，男性187例（84.62%），女性34例（15.38%），年齡33～88歲（平均為60.02±10.98歲）患者納入研究對(duì)象。221例患者共檢測(cè)椎-基底動(dòng)脈655條，其中左側(cè)椎動(dòng)脈218條（33.28%），，右側(cè)椎動(dòng)脈216條（32.98%），椎動(dòng)脈共434條（66.26%），基底動(dòng)脈221條（33.74%），其中8例為單側(cè)椎動(dòng)脈。TCD檢查提示正常血管350條（53.44%），狹窄血管為305條（46.56%）。MRA檢查提示正常血管324條（49.47%），其中基底動(dòng)脈118條，左側(cè)椎動(dòng)脈108條，右側(cè)椎動(dòng)脈98條；狹窄血管為331條（50.53%），其中基底動(dòng)脈103條，左側(cè)椎動(dòng)脈110條，右側(cè)椎動(dòng)脈118條。 以MRA檢測(cè)結(jié)果為參照，顯示TCD診斷椎動(dòng)脈狹窄或閉塞的敏感性、特異性、假陽(yáng)性率、假陰性率分別為78.95%、83.98%、16.02%、21.05%，符合率81.34%、Kappa值0.6226；TCD診斷基底動(dòng)脈狹窄或閉塞的敏感性、特異性、假陽(yáng)性率、假陰性率分別為79.61%、91.53%、8.47%、20.39%，符合率85.97%、Kappa值0.7162(95%置信下限0.6241，95%置信上限0.8083)。TCD診斷椎-基底動(dòng)脈總體狹窄或閉塞的敏感性、特異性、假陽(yáng)性率、假陰性率分別為79.15%、86.73%、13.27%、20.85%，符合率82.90%、Kappa值0.6583(95%置信下限0.6008，95%置信上限0.7157)。 結(jié)論：TCD對(duì)椎-基底動(dòng)脈狹窄或閉塞的診斷具有較高的特異性和敏感性，且特異性高于敏感性。TCD可較準(zhǔn)確地判斷椎-基底動(dòng)脈有無(wú)狹窄，且TCD與MRA有很好的一致性。TCD檢測(cè)方法結(jié)果可靠，是臨床作為初步篩查椎-基底動(dòng)脈狹窄的首選方法。
[Abstract]:Aim: to evaluate the diagnostic value of transcranial Doppler (TCD) (TCD) in the diagnosis of vertebral artery (Vertebral artery,VA) and basilar artery (Basilar artery,BA) stenosis using magnetic resonance angiography (MRA) as a definite diagnosis method. Methods: from July 2013 to October 2014 in Bethune first Hospital of Jilin University, 221 patients with ischemic cerebrovascular disease with abnormal vertebrobasilar blood flow were examined by TCD and MRA was performed within one week. The results of vertebrobasilar artery detection by two methods were compared. According to the results of MRA, they were divided into normal group and stenosis group. The peak systolic velocity (Peak Systolic Velocity,PSV), diastolic velocity (End Diastolic Velocity,EDV) and mean velocity (Mean Flow Velaocity,MFV) of vertebrobasilar artery in each group were recorded by TCD. Arterial pulsatility index (PI),) spectrum morphology and sound frequency characteristics were compared and analyzed between the two groups. Kappa value is used to measure the consistency between TCD and MRA. Results: 221 patients, 187 males (84.62%) and 34 females (15.38%), aged 33 to 88 years (average 60.02 鹵10.98 years) were enrolled in the study. 655 vertebrobasilar arteries were detected in 221 patients. There were 218 left vertebral arteries (33.28%), 216 right vertebral arteries (32.98%), 434 vertebral arteries (66.26%) and 221 basilar arteries (33.74%). TCD showed 350 normal vessels (53.44%), 305 stenotic vessels (46.56%), 324 normal arteries (49.47%), 118 basilar arteries. There were 108 left vertebral arteries and 98 right vertebral arteries. The number of stenosis vessels was 331 (50.53%), of which 103 were basilar artery, 110 were left vertebral artery and 118 were right vertebral artery. The sensitivity, specificity, false positive rate and false negative rate of TCD in the diagnosis of vertebral artery stenosis or occlusion were 78.95%, 83.98%, 16.02%, 21.05%, respectively, and the coincidence rate was 81.34%. Kappa value 0.6226; The sensitivity, specificity, false positive rate and false negative rate of TCD in the diagnosis of basilar artery stenosis or occlusion were 79.61%, 91.53%, 8.47%, 20.39%, respectively, and the coincidence rate was 85.97%. The sensitivity, specificity, false positive rate and false negative rate of Kappa in the diagnosis of vertebrobasilar artery stenosis or occlusion were 79.15%, 86.73%, 13.27%, respectively, and the sensitivity, specificity, false positive rate and false negative rate were 79.15%, 86.73%, 13.27%, respectively. The Kappa value was 0.6583 (95% confidence lower limit 0.6008, 95% confidence upper limit 0.7157). Conclusion: TCD has high specificity and sensitivity in the diagnosis of vertebrobasilar artery stenosis or occlusion, and the specificity is higher than that of sensitivity. The results of TCD were reliable and it was the first choice for screening vertebrobasilar artery stenosis.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 史恒峰;韓萍;吳發(fā)銀;桂廣華;陳平;余佑高;;64層螺旋CT數(shù)字減影后造影對(duì)頭頸部血管狹窄性疾病診斷價(jià)值[J];臨床放射學(xué)雜志;2011年09期

2 繆黃泰;聶紹平;;CT相關(guān)造影劑腎病[J];中華實(shí)用診斷與治療雜志;2013年11期

3 殷宇慧;劉文宏;虞峰;王卉;高鳳蓮;盧欣;陳靖;賀茂林;;經(jīng)顱多普勒超聲檢測(cè)后循環(huán)動(dòng)脈狹窄或閉塞的敏感性和特異性[J];中華老年心腦血管病雜志;2013年06期

4 呂京光,柳澄,武樂(lè)斌,滿曉,冷振璞;MSCT行腦CTPI聯(lián)合CTA在診斷超早期急性缺血性腦血管病中的應(yīng)用研究[J];醫(yī)學(xué)影像學(xué)雜志;2003年07期

5 田家瑋;高敬;孫立濤;付礦;;經(jīng)顱彩色多普勒超聲診斷顱內(nèi)段椎-基底動(dòng)脈狹窄的應(yīng)用價(jià)值[J];中國(guó)超聲醫(yī)學(xué)雜志;2006年03期

6 張彬彬;石劍寬;林宏;李柱一;;TCD對(duì)顱內(nèi)動(dòng)脈狹窄或閉塞診斷的臨床研究[J];中國(guó)臨床神經(jīng)外科雜志;2011年01期

7 杜湘珂，朱錫旭，沈復(fù)興，羅德馨;螺旋CT血管造影[J];中華放射學(xué)雜志;1995年03期

8 胡善娜;呂敬雷;趙仁亮;;后循環(huán)腦梗死的血管影像學(xué)檢查[J];中華腦血管病雜志(電子版);2011年04期

9 李秀花;徐長(zhǎng)波;趙麗玲;;TCD和CDFI聯(lián)合檢測(cè)對(duì)椎-基底動(dòng)脈狹窄的診斷價(jià)值[J];中國(guó)現(xiàn)代醫(yī)藥雜志;2011年03期

10 魯楊;方樂(lè);閆亞韻;尹帥;王輝;;經(jīng)顱多普勒超聲診斷顱內(nèi)動(dòng)脈狹窄與CT腦血管造影的對(duì)比分析[J];中國(guó)實(shí)驗(yàn)診斷學(xué);2012年01期

本文編號(hào)：2431517