【作者】 尹蓉；

【导师】 田发发；

【作者基本信息】 中南大学 ， 神经病学， 2012， 硕士

【摘要】 目的本课题以高血压患者为研究对象,联合颈部血管彩超和经颅多普勒检查,探讨高血压病程对颈动脉、脑动脉粥样硬化的影响,为高血压性脑血管事件提供重要的一级预防依据。方法收集符合高血压病诊断标准的患者135例,依据高血压病程的不同,分为<5年组、5-10年组及>10年组3个实验组,并收集同时期就诊的血压正常患者共61例为对照组。其一,用10Mz超声探头探测双侧颈总动脉(common carotid artery, CCA)、颈外动脉(external carotid artery, ECA)及颈内动脉(internal carotid artery, ICA)颅外段血管,于颈动脉分叉处近心端1-2cm处测量内膜-中膜厚度(intima-media thickness, IMT);观察有无斑块形成,记录斑块大小、数目及部位,对所发现斑块进行大小半定量积分；同时测量斑块远心端管腔直径,计算管径狭窄比值。其二,运用2Mz脉冲多普勒探头经颞窗探测双侧大脑中动脉(middle cerebral artery, MCA)、大脑前动脉(anterior cerebral artery, ACA)作为前循环代表,经枕窗探测基底动脉(basal artery, BA)、双侧椎动脉(vertebral artery, VA)作为后循环代表。记录血流速度(Vp、Vd、Vm)、搏动指数(pulsatility index, PI)、阻力指数(resistent index, RI);观察频谱形态、血流方向,监听声频；在经颅多普勒(transcranial Doppler, TCD)频谱中选取单心动周期的频谱,确定每个心动周期的起始点(t0)、重脉搏切迹点(ti)、终结点(te)和速度达峰值的时间点(tp),根据公式计算峰时指数-1(TPI-1)和峰时指数-2(TPI-2)。结果(1)高血压患者各亚组颈动脉IMT值均高于对照组(P<0.05)；病程>10年组颈动脉IMT值高于病程<5年组及病程5-10年组(P<0.05)；随着高血压病程增加,IMT逐渐增厚,呈直线相关(P<0.05)。(2)与对照组相比,高血压各亚组存在颈动脉粥样斑块的患者比例增高(P<0.05)；且病程>10年组比例大于病程<5年组(P<0.05)。(3)对照组与高血压组斑块大小半定量积分构成有显著性差异(P<0.05)；高血压各亚组间斑块大小半定量积分构成有显著性差异(P<0.05)。(4)与对照组相比,病程5-10年组与病程>10年组颈动脉管径狭窄比值增加(P<0.05)；病程>10年组与病程<5年组相比,颈动脉管径狭窄比值增加(P<0.05)。(5)高血压组的TCD频谱形态异常率高于对照组(P<0.05)；病程>10年组BA、LMCA的TCD频谱形态异常率高于病程<5年红(P<0.05)。(6)高血压各亚组所测血管PTI-1、PTI-2均高于对照组(P<0.05)；BA、MCA的PTI-1、PTI-2值与高血压病程的直线相关分析显示,随着高血压病程增加,BA、MCA的PTI-1、PTI-2值增加,两者呈直线相关(P<0.05)。(7)病程>10年组血管PL、RI值均高于对照组(P<0.05)；病程>10年组血管PL、RI值高于病程<5年组及病程5-10年组(P<0.05)；BA、MCA的PI、RI值与高血压病程的直线相关分析显示,随着高血压病程增加,BA、MCA的PI、RI值增加,两者呈直线相关(P<0.05)。(8)与对照组相比,高血压各组颅内动脉狭窄率显著增高(P<0.01)。病程>10年组颅内动脉狭窄率显著高于病程<5年组(P<0.05)。结论高血压与颈动脉、脑动脉粥样硬化密切相关,高血压病程越长,动脉粥样硬化程度越严重。更多还原

【Abstract】 Objective Combined transcranial doppler and carotid chromatic ultrasound to detect the carotid and cerebral atherosclerosis lesions in patients with hypertension, so as to explore the relevance between hypertension, duration and atherosclerosis, and to provide primary prevention evidences for hypertensive cerebrovascular events.Methods135patients with hypertension were collected and divided to3groups according to their duration, i.e.<5years,5-10yeas and>5years groups. On one hand, Using10MHz carotid chromatic ultrasound probe, bilateral common carotid artery(CCA), internal carotid artery(ICA) and extracranial part of external carotid artery(ECA) were detected. We measured the bilateral intima-medial thickness(IMT) of CCA on the place from carotid bifuracation1-2cm and recorded the amount, size and location of atheromatous plaques, as well as the characteristics and stenosis ratio. On the other hand, Using2MHz pulse doppler probe through bilateral temporal windows and pillow windows, the blood flow velocity(Vp、Vd、Vm), pulsatility index(PI), resistance index(RI) were recorded. Anterior cerebral artery(ACA) and middle cerebral artery(MCA) were regarded as the representative of the anterior circulation of intracranial artery, while basal artery(BA) and vertebral artery(VA)as that of the posterior circulation. In TCD spectrum, we selected the spectrum of a single-family cardiac cycle, identified the starting point(t0), the pulse-incisure point(ti), the end point(te) and the peak velocity point(tp), measured the time of the spectrum starting point to the peck velocity point(PT)and then calculated the time required of the peak velocity in the share of ventricular systolic(PTI-1)as well as the time required of the peak velocity point in the share of the whole cardiac cycle(PTI-2). Results(1) Carotid IMT of hypertension subgroups was significantly thickened compared with control group(P<0.05); carotid IMT of duration>10years subgroup was significantly thicker than that of5-10years subgroup; with the increase of duration, IMT became thicker, and there was a linear correlation between them(P<0.05).(2) The proportion of patients with carotid arterial atheromatous plaques in hypertension subgroups was significantly larger than that in control group(P<0.05); Meanwhile, the proportion in duration>10years subgroup was larger than that in duration<5years subgroup(P<0.05).(3) The plaques size scores between hypertension and control group were significantly different(P<0.05); there were significant differences among hypertension subgroups as well(P<0.05).(4) Carotid stenosis ratio of duration between5and10years and>10years subgroups was elevated compared with control group(P<0.05); compared with duration<5years subgroup, duration>10years subgroup had significantly increased carotid stenosis ratio(P<0.05).(5) The rate of abnormal TCD spectrum in hypertension group was significantly increased(P<0.05);the rate of BA and LMCA abnormal TCD spectrum in duration>10years subgroup was increased compared with that in duration<5years subgroup(P<0.05).(6) The PTI-1and PTI-2values in hypertension subgroups were higher than that in control group(P<0.05). The linear correlation analysis of PTI-1, PTI-2values and hypertension duration in BA, MCA showed that with the increase of duration, both values were elevated, and there was a linear correlation between them(P<0.05).(7) PI and RI values in duration>10years subgroup were increased compared with control group (P<0.05). PI and RI values in duration>10years subgroup were increased compared with duration<5years and between5and10years subgroups(P<0.05); the linear correlation analysis of PI, RI values and hypertension duration in BA and MCA showed that, with the duration increasing, PI and RI values were elevated, and there was a linear correlation between them(P<0.05).(8) Intracranial arterial stenosis rate of hypertension subgroups was increased compared with control group(P<0.01). Meanwhile, that of duration>10years subgroup was significantly higher than that of duration<5years subgroup(P<0.05).更多还原