Sun L, Zhang X L, Zhang H J
Department of Neurology, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Yi Xue Za Zhi. 2016 Jun 21;96(23):1834-7. doi: 10.3760/cma.j.issn.0376-2491.2016.23.010.
To determine the clinical value of cerebrovascular hemodynamics analysis (CVA) on cerebral microcirculation.
One hundred consecutive patients from neurological department of Peking University People's Hospital from April to October, 2015, with symptoms of dizziness, lightheadedness, headache etc., who were diagnosed with ischemic cerebrovascular disease with normal transcranial doppler (TCD) and abnormal CVA, were recruited in this study.Other medical conditions were excluded through clinic and imaging examinations among these patients.Patients were categorized into mild, moderate and severe subgroups based on the degrees of decreased blood flow velocity and/or volume, and received treatment accordingly.CVA parameters including the minimum flow velocity (Vmin), the minimum flow volume (Qmin), peripheral resistance (R), critical pressure (CCP) and dynamic resistance (CVR) etc.before and after treatment were compared statistically (t test).
Out of the 100 patients with abnormal CVA, 52 patients had bilateral changes and 48 patients had unilateral changes.The minimum flow velocity and the minimum flow volume anomalies were found in 100 and 92 cases, respectively.A total of 47, 32 and 21 patients had mild, moderate and severe abnormal changes, respectively.Out of the 63 patients who had follow-up CVA after treatment (drop-out 37 cases), there were 63 abnormal Vmin cases, 60 abnormal Qmin cases, 17 abnormal R cases, 18 abnormal CCP cases, 41 abnormal characteristic impedance (Zc) cases, 41 abnormal elastic wave velocity (Wv) cases, 23 abnormal vascular compliance (C) cases, all before treatment.After treatment, symptoms and Vmin synchronization improved in 61 cases (96.8%), Qmin improved in 58 cases (96.6%), R improved in 13 cases (76.5%), CCP improved in 10 cases (55.6%), Zc improved in 27 cases (65.8%), Wv improved in 25 cases (61.0%), C improved in 6 cases (26.1%). All improvements were statistically significant (P<0.05), with Vmin, Qmin, R and CCP showing most significant changes (P<0.000 1). The CVR treatment showed no significant before and after treatment (P>0.05).
CVA is an important method in assessing cerebral microcirculation perfusion, providing information on intracranial microvascular bed that cannot be detected by TCD.It is not only helpful for diagnosis, but also evaluable for monitoring clinical treatment of cerebral microcirculation disorder.CVA is also helpful in determining the location of cerebral circulation impairment by correlation with carotid ultrasound and TCD.
探讨脑血管血流动力学分析（CVA）对脑微循环的临床价值。
选取2015年4月至10月北京大学人民医院神经内科连续收治的100例有头晕、头重、头痛等症状，经颅多普勒（TCD）正常但CVA异常，诊断为缺血性脑血管病的患者。通过临床及影像学检查排除其他疾病。根据血流速度和/或血流量降低程度将患者分为轻、中、重度亚组，并给予相应治疗。比较治疗前后CVA参数，包括最小血流速度（Vmin）、最小血流量（Qmin）、外周阻力（R）、临界压力（CCP）和动态阻力（CVR）等（t检验）。
100例CVA异常患者中，双侧改变52例，单侧改变48例。最小血流速度异常100例，最小血流量异常92例。轻度、中度、重度异常改变分别为47例、32例、21例。治疗后进行CVA随访的63例患者（失访37例），治疗前Vmin异常63例，Qmin异常60例，R异常17例，CCP异常18例，特征阻抗（Zc）异常41例，弹性波速（Wv）异常41例，血管顺应性（C）异常23例。治疗后，61例（96.8%）症状与Vmin同步改善，58例（96.6%）Qmin改善，13例（76.5%）R改善，10例（55.6%）CCP改善，27例（65.8%）Zc改善，25例（61.0%）Wv改善，6例（26.1%）C改善。所有改善均有统计学意义（P<0.05），Vmin、Qmin、R和CCP变化最显著（P<0.000 1）。CVR治疗前后差异无统计学意义（P>0.05）。
CVA是评估脑微循环灌注的重要方法，可提供TCD无法检测到的颅内微血管床信息。它不仅有助于诊断，还可用于监测脑微循环障碍的临床治疗效果。通过与颈动脉超声和TCD联合，CVA有助于确定脑循环障碍的部位。
