【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）評估椎動脈（Vertebral artery，VA）和基底動脈（Basilar artery，BA）狹窄臨床診斷中的應(yīng)用價值。 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，比較兩種方法對椎-基底動脈的檢測結(jié)果。依據(jù)MRA結(jié)果分為正常組與狹窄組，TCD檢測記錄各組中椎-基底動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）、動脈搏動指數(shù)（PI）、頻譜形態(tài)及聲頻特征等，并對兩組檢測結(jié)果進行對比分析。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）患者納入研究對象。221例患者共檢測椎-基底動脈655條，其中左側(cè)椎動脈218條（33.28%），，右側(cè)椎動脈216條（32.98%），椎動脈共434條（66.26%），基底動脈221條（33.74%），其中8例為單側(cè)椎動脈。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%），其中基底動脈118條，左側(cè)椎動脈108條，右側(cè)椎動脈98條；狹窄血管為331條（50.53%），其中基底動脈103條，左側(cè)椎動脈110條，右側(cè)椎動脈118條。 以MRA檢測結(jié)果為參照，顯示TCD診斷椎動脈狹窄或閉塞的敏感性、特異性、假陽性率、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診斷基底動脈狹窄或閉塞的敏感性、特異性、假陽性率、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-基底動脈總體狹窄或閉塞的敏感性、特異性、假陽性率、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對椎-基底動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-基底動脈有無狹窄，且TCD與MRA有很好的一致性。TCD檢測方法結(jié)果可靠，是臨床作為初步篩查椎-基底動脈狹窄的首選方法。
[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)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R743.3

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