颈部血管超声评估颅内段椎动脉狭窄与症状性缺血性脑血管病的相关性研究

Correlation between intracranial vertebral artery stenosis assessed by cervical vascular ultrasound and symptomatic ischemic cerebrovascular disease

摘要:

目的 通过颈部血管超声评估颅内段椎动脉狭窄，探讨其与症状性缺血性脑血管病（ICVD）的相关性。方法 纳入2023年4月至2025年3月于上海交通大学医学院苏州九龙医院进行颈部血管超声检查，并经计算机体层血管成像和（或）数字减影血管造影证实存在单侧椎动脉颅内段狭窄的患者（180例）作为研究组，回顾性收集其临床、影像学及超声资料。另纳入同期超声检查正常的健康体检者（60名）作为对照组。依据狭窄程度将研究组分为轻度狭窄组（81例）、中度狭窄组（54例）、重度狭窄组（45例）；依据有无ICVD的相关症状分为无症状组（75例）与症状组（105例）。比较各组血流参数；采用多因素Logistic回归分析评估症状性ICVD的影响因素；采用受试者操作特征（ROC）曲线及曲线下面积（AUC）评估各参数诊断效能；采用限制性立方样条模型分析血流参数与重度狭窄患者症状性ICVD发生风险之间的剂量-反应关系。结果 随椎动脉狭窄程度加重，收缩期峰值流速（PSV）、舒张末期流速（EDV）、椎动脉直径（VAD）、血流量逐渐下降（P<0.05）；血管的阻力指数（RI）逐渐升高（P<0.05）。患侧PSV、EDV、VAD、血流量低于健侧（P<0.05）；RI高于健侧（P<0.05）。ROC曲线分析显示，各指标联合诊断时，对诊断中／重度狭窄的AUC为0.864，重度狭窄的AUC为0.891。症状组PSV、EDV、血流量低于无症状组（P<0.05）；RI高于无症状组（P<0.05）。多因素Logistic回归分析显示，PSV<50.03 cm/s、EDV<20.12 cm/s、RI≥0.60、血流量<101.31 mL/min及重度狭窄是症状性ICVD的危险因素（P<0.05）。剂量-反应关系显示，上述参数与重度狭窄患者症状性ICVD发生风险呈非线性关联。结论 PSV、EDV、RI、血流量与椎动脉颅内段狭窄程度及症状性ICVD风险相关，各指标联合评估有助于临床筛查和风险评估。

Abstract:

Objective To evaluate intracranial vertebral artery stenosis using cervical vascular ultrasound and explore its correlation with symptomatic ischemic cerebrovascular disease （ICVD）.Methods From April 2023 to March 2025， 180 patients who underwent cervical vascular ultrasound examination at Suzhou Kowloon Hospital， Shanghai Jiao Tong University School of Medicine， and were confirmed to have unilateral stenosis or occlusion of the intracranial segment of the vertebral artery by computed tomography angiography and/or digital subtraction angiography were selected as the study group. Their clinical， imaging， and ultrasound data were retrospectively collected. In addition， 60 healthy individuals with normal ultrasound examination findings during the same period were included as the control group. Based on the degree of stenosis， patients in the study group were divided into mild （n=81）， moderate （n=54）， and severe （n=45） stenosis groups； based on the presence or absence of ICVD-related symptoms， they were divided into an asymptomatic group （n=75） and a symptomatic group （n=105）. The blood flow parameters were compared among groups. Multivariable Logistic regression analysis was used to evaluate the factors influencing symptomatic ICVD. Receiver operating characteristic curves and the area under the curve （AUC） were used to evaluate the diagnostic efficacy of these parameters. A restricted cubic spline model was used to analyze the dose-response relationship between blood flow parameters and the risk of symptomatic ICVD in patients with severe stenosis.Results As the degree of vertebral artery stenosis increased， the peak systolic velocity （PSV）， end-diastolic velocity （EDV）， vertebral artery diameter， and blood flow gradually decreased （P<0.05）， while the vascular resistance index （RI） gradually increased （P<0.05）. The PSV， EDV， vertebral artery diameter， and blood flow on the affected side were lower than those on the healthy side （P<0.05）， whereas the RI was higher than that on the healthy side （P<0.05）. Receiver operating characteristic curve analysis showed that when the parameters were combined for diagnosis， the AUC for the diagnosis of moderate/severe stenosis was 0.864， and the AUC for severe stenosis was 0.891. The PSV， EDV， and blood flow in the symptomatic group were lower than those in the asymptomatic group （P<0.05）， while the RI was higher than that in the asymptomatic group （P<0.05）. Multivariable Logistic regression analysis showed that PSV<50.03 cm/s， EDV<20.12 cm/s， RI≥0.60， blood flow<101.31 mL/min， and severe stenosis were independent risk factors for symptomatic ICVD （P<0.05）. The dose-response relationship showed that the above parameters had a non-linear association with the risk of ICVD in patients with severe stenosis.Conclusions PSV， EDV， RI， and blood flow are correlated with the degree of intracranial vertebral artery stenosis and the risk of symptomatic ICVD. A combined of these parameters is helpful for clinical screening and risk assessment.