椎基底动脉迂曲扩张症的计算流体力学分析

目的 基于磁共振血管造影(MRA)的椎基底动脉迂曲扩张症(VBD)计算机流体力学分析。方法 选取2018年1月至2022年1月牡丹江医学院附属红旗医院诊断为VBD的40例患者,经MRI检查正常的40例患者图像。以椎基底动脉MRA图像构建椎基底动脉三维几何模型,分为VBD组与对照组,分析血流速度(V)、壁面剪切应力(WSS)及震荡剪切系数(OSI)。结果 VBD组V、WSS及OSI均高于对照组,差异有统计学意义(P <0.05)。在血流速度方面,高速血流集中于基底动脉及右侧大脑后动脉处。在WSS方面,VBD组高WSS位于右侧椎动脉、基底动脉、双侧大脑后动脉等大部分血管区域,以血管分叉处显著。在OSI方面,VBD组高OSI值以基底动脉末端至双侧大脑后动脉发出处明显,其余血管区域为波动性高OSI分布。结论 基于真实磁共振患者图像可建立三维个体化血管模型及进行血流动力学分析,获取VBD血流速度图、血管剪切应力云图及震荡剪切系数云图。建立VBD组及对照组模型,分析血流动力学发现,VBD组的基底动脉段具有高速血流、高WSS及高OSI,以末端显著,临床上应着重关注此区域。     

椎基底动脉延长扩张症与缺血性脑卒中经颅多普勒超声特点及临床预后

目的探讨缺血性脑卒中患者合并椎基底动脉延长扩张症的血流动力学特点及对临床预后的影响。方法回顾性分析年龄≥65岁的急性缺血性脑卒中患者239例,依据影像学表现判断椎基底动脉延长扩张症(VBD),分为VBD组和非VBD组。观察两组血流动力学特点。结果VBD与非VBD组基底动脉的平均血流速度(MFV)和搏动指数(PI值)差异有统计学意义。两组病后24 h内1、3、6个月美国国立卫生研究所脑卒中量表(NIHSS)评分差异有统计学意义。结论 VBD患者后循环血流速度慢,且动脉搏动减弱。VBD患者在发生缺血性脑卒中时神经功能损伤程度较重,且恢复程度慢。     

椎-基动脉延长扩张症的磁共振成像和磁共振血管造影

椎-基动脉延长扩张症(VBD)是一种依据神经放射学检查诊断的椎-基底动脉伸长和扩张症。根据 Smoker定义:VBD一词只适用于基底动脉位于小脑桥脑角斜坡外缘或鞍上池上方,且其直径大于4.5mm者。 由于VBD与临床症状之间缺乏明确关系,无论损伤性血管造影或极少损伤的CT增强与磁共振成像(MRI)都易出现误诊。目前已可常规采用MRI合用无损伤性磁共振血管造影(MRA)技术,借助血流中的磁性进行诊断。     

载脂蛋白Eε4基因型对阿尔茨海默病患者脑血流的影响分析

［摘要］　目的　分析载脂蛋白E（APOE）ε4基因型对阿尔茨海默病（AD）患者脑血流的影响。方法　选择2020年4月至2021年4月深圳市罗湖区人民医院收治的AD患者31例为观察组;另选择同期认知功能正常的老年健康者25名为对照组。所有患者采用简明精神状态量表(MMSE)评估认知功能。采用经颅多普勒超声（TCD）检测颅内动脉的平均血流速度（MFV）和搏动指数（PI）。采用实时荧光定量聚合酶链式反应（qRT-PCR）检测AD患者的APOE基因型,分析APOEε4基因型对AD患者脑血流的影响。结果　观察组双侧大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)、椎动脉(VA)以及基底动脉(BA)的MFV均低于对照组,PI高于对照组,差异有统计学意义（P<0.05）。Pearson相关性分析结果显示,AD患者的MMSE评分与颅内动脉的MFV呈正相关（P<0.05）,与PI呈负相关（P<0.05）。ROC曲线分析结果显示,颅内动脉的MFV和PI均有诊断AD的应用价值（P<0.05）,各指标的AUC>0.70。31例AD患者中有26例患者行APOE基因检测,11例(42.31%)为APOEε4型。APOEε4型组的MMSE评分较非APOEε4型组低,差异有统计学意义［(19.50±8.62)分 vs (24.15±5.14)分;t=2.322,P=0.030］。APOEε4型组颅内动脉的MFV较非APOEε4型组低,PI较非APOEε4型组高,差异均有统计学意义（P<0.05）。结论　AD患者存在以MFV降低、PI升高为特征的脑血流动力学改变,认知功能损害程度与脑血流动力学变化显著相关,且携带APOEε4基因型可引起更严重的认知功能损害和脑血流动力学改变。     

临床表现为进展性脑干梗死、脑神经及脑干压迫的基底动脉延长扩张症：1例报告并文献复习

椎基底动脉延长扩张症( vertebrobasilar dolichoectasia, VBD)是一种少见的以椎基底动脉显著增长、增粗和扭曲为特点的脑血管病,一般认为与大血管结缔组织结构和功能异常有关。 VBD 患者临床表现各异：(1)无症状和体征;(2)椎基底动脉供血区急性缺血性卒中,最常见梗死部位为脑干;(3)慢性进展性症状,与脑神经、脑干或第三脑室受压有关;(4)血管破裂引起致死性症状[1-2]。表现为进展性脑干梗死和脑神经和脑干受压的 VBD 少见,现报道1例。     

椎-基底动脉延长扩张症压迫延髓及锥体束所致下肢行走启动困难一例报道并文献复习

椎-基底动脉延长扩张症(VBD)是一种以基底动脉或椎动脉颅内段明显扩张、延长和迂曲为特征的血管变异性疾病,其于1761年由意大利解剖学家首次发现,后经SMORKER等定义为VBD并沿用至今,但其具体发病机制目前尚不完全明确。VBD临床表现多样,本文报道了1例VBD压迫延髓及锥体束所致下肢行走启动困难患者,并进行了文献复习,旨在提高临床对该病的认识。     

磁共振对椎基底动脉延长扩张症的诊断价值分析

目的探讨椎基底延长扩张症临床表现与MRI及MRA的影像特点,以提高磁共振在椎基底动脉延长扩张症(VBD)检查、诊断中的重要性。方法分析30例病人的临床症状及影像表现。结果三叉神经受累7例,面神经受累8例,听神经受累2例,后循环梗死脑实质受累型5例,后循环供血不足6例,脑出血6例,脑积水1例。所有病人直径扩张超过4.5mm,椎动脉颅内段长度超过23.5mm,基底动脉长度超过30mm,所有病人均有明显偏移,15例向右侧偏移,8例向左侧偏移。结论 MRI及MRA可显示椎基底动脉形态及与邻近组织的解剖关系,对椎基底动脉扩张延长症诊断提供直观依据。     

椎基底动脉扩张延长症15例临床分析

<正>椎基底动脉扩张延长症(vertebrobasilar dolichoectasia,VBD)是指椎基底动脉的异常迂曲、扩张和延长,是一种少见的后循环血管变异性脑血管病,虽然发病率低,但由于椎基底动脉扩张、延长对脑神经、脑干的压迫以及后循环缺血等改变,致残及致死率较高。近年来越来越多的研究显示,VBD可能是后循环卒中的独立危险因素。本文回顾分析了我院15例VBD病人的临床表现及诊治方法,以期提高对这一疾病的认识及重视。     

椎基底动脉延长扩张症与高血压

<正>椎基底动脉延长扩张症(vertebrobasilar dolichoectasia,VBD)是一种临床少见的动脉病,表现为椎基底动脉的扩张、迂曲和延长,是对一种病理改变的描述,可能是单一疾病,也可能是不同疾病的共同病理改变。该病的成因十分复杂,目前,还没有完整的病理生理机制描述。动脉壁发育异常的先天因素~[1-2]与动脉粥样硬化等多种后天危险因素~[3]共同作用,异常的动脉管壁在血管力学的作用下,出现血管的延长扩张。VBD临床表现多种多样     

帕金森病伴疼痛患者临床特征及认知功能研究

 目的 探讨伴慢性疼痛的帕金森病(PD)患者疼痛类型及危险因素,并分析疼痛与认知功能的相关性。方法 116例原发性PD患者分为伴疼痛组与不伴疼痛组,统一使用PD评分量表(UPDRS)、Hoehn-Yahr(H-Y)分期,汉密顿抑郁量表(HRSD,24项)、视觉模拟评分法(VAS)、蒙特利尔认知评估量表(MoCA)等进行评估。结果 伴慢性疼痛组UPDRS各项得分、H-Y分期及HRSD得分均高于不伴疼痛组,差异均有统计学意义(P值均<0.05)。logistic回归分析显示只有HRSD得分有统计学意义(OR=1.093,P=0.007)。伴慢性疼痛PD患者的“延迟记忆”得分低于不伴疼痛患者(1.9±1.3比2.5±1.3),差异有统计学意义(P=0.020);疼痛出现在运动症状之前患者的延迟记忆得分明显低于疼痛出现于运动症状以后的患者(1.2±1.2比2.2±1.3),差异有统计学意义(P=0.015)。结论 骨骼肌疼痛是PD患者最为常见的疼痛类型,抑郁可能是导致PD合并疼痛的独立危险因素,伴慢性疼痛PD患者的认知功能损害主要表现为延迟记忆障碍。     

Applications of coronary flow velocity during angioplasty and other coronary interventional procedures

Previous studies utilizing Doppler catheters to assess blood flow immediately following coronary artery interventions have failed to demonstrate significant improvement in proximal coronary artery velocities or vasodilator reserve. Measurement of Mood flow velocity, flow reserve, and the phasic diastolic/systolic velocity ratio in the distal coronary artery has been performed following various interventional procedures utilizing a low profile (.018 in) Doppler angioplasty guidewire. Following balloon angioplasty in 38 patients, average peak velocity increased significantly from 19 ± 12 to 35 ± 16 cm/sec in the distal coronary artery. The diastolic/systolic flow ratio improved from 1.3 ± 0.5 to 1.8 ± 0.5 and coronary flow reserve remained unchanged. Similar improvement in distal mean velocities (200%) versus proximal mean velocities (90% increase), and improvement in phasic velocity patterns, total velocity integral, and peak diastolic velocity were also noted in a separate study of 29 patients, before and after balloon angioplasty.Following excimer laser angioplasty in 10 patients, average peak velocity in the distal coronary artery was noted to increase from 6.3 to 13.0 cm/sec following laser alone, with a further increase to 20.6 cm/sec following adjunctive balloon angioplasty. The diastolic/systolic flow ratio increased from a mean value of 1.1 to 2.0 following laser recanalizatkm, with a further increase to 2.9 following adjunctive balloon angioplasty. Following directional coronary atherectomy only modest improvement in distal average peak velocity was noted (24.7 to 33.2 cm/sec), with no significant change in diastolic/systolic velocity ratio (1.78 vs 2.04) immediately following the procedure. Measurement of distal flow velocity parameters performed immediately following coronary interventions may prove useful in assessing the hemodynamic result of these interventions and may prove useful in clinical decision making.     

严重颈内动脉狭窄时眼动脉血流变化的研究

目的:探讨严重颈内动脉狭窄(internal carotid artery stenosis,ICAS)时眼部血流的变化。方法:2011年10月至2012年10月间,于我院脑卒中中心收治的50例单侧颈内动脉重度以上狭窄住院患者进行详尽的眼部检查、视网膜中央动脉(central retinal artery,CRA)彩色多普勒血流检查、全脑动脉及主动脉弓数字减影血管造影(digital subtraction angiography,DSA)等检查。结果:50例患者经DSA证实有20例存在眼动脉血液逆流。在20例眼动脉逆流患者中,出现过急性眼部缺血症状11例,出现过不同的慢性眼部缺血症状15例。患者有明确的眼部缺血体征9例。20例逆流患者的CRA的收缩期峰值血流速度(peak systolic velocity,PSV)为(7.16±1.33)cm/s与另外30例眼动脉正向血流患者的CRA的PSV(7.64±1.28)cm/s相比较,并没有明显降低,差异无统计学意义(t=-1.275,P=0.209)。结论:严重的ICAS时,出现眼动脉血液逆流,并不一定会发生眼部缺血性病变。眼动脉血液逆流是眼部缺血产生的高危因素,并不是决定因素。     

Association between carotid hemodynamics and asymptomatic white and gray matter lesions in patients with essential hypertension.

The aim of this study was to clarify the magnitude of common carotid artery (CCA) structural and hemodynamic parameters on brain white and gray matter lesions in patients with essential hypertension (EHT). The study subjects were 49 EHT patients without a history of previous myocardial infarction, atrial fibrillation, diabetes mellitus, impaired glucose tolerance, chronic renal failure, symptomatic cerebrovascular events, or asymptomatic carotid artery stenosis. All patients underwent brain MRI and ultrasound imaging of the CCA. MRI findings were evaluated by periventricular hyperintensity (PVH), deep and subcortical white matter hyperintensity (DSWMH), and état criblé according to the Japanese Brain dock Guidelines of 2003. Intima media thickness (IMT), and mean diastolic (Vd) and systolic (Vs) velocities were evaluated by carotid ultrasound. The Vd/Vs ratio was further calculated as a relative diastolic flow velocity. The mean IMT and max IMT were positively associated with PVH, DSWMH, and état criblé (mean IMT: rho=0.473, 0.465, 0.494, p=0.0007, 0.0014, 0.0008, respectively; max IMT: rho=0.558, 0.443, 0.514, p=0.0001, 0.0024, 0.0004, respectively). Vd/Vs was negatively associated with état criblé (rho=-0.418, p=0.0038). Carotid structure and hemodynamics are potentially related to asymptomatic lesions in the cerebrum, and might be predictors of future cerebral vascular events in patients with EHT.     

椎动脉型颈椎病的彩色多普勒超声检测

为探讨超声检测颈椎病合并椎动脉供血不足的价值 ,运用彩色多普勒超声观察了 5 0例椎动脉型颈椎病患者椎动脉的形态结构 ,检测其血流速度、阻力指数、搏动指数和血流量。将测得的各参数进行统计学处理 ,结果发现 ,与对照组相比 ,颈椎病组椎动脉的阻力指数和搏动指数明显增高 (P <0 .0 5 ) ,而峰值流速、舒张末期流速和血流量轻微下降 (P >0 .0 5 ) ,但差异无显著性。以上提示 ,彩色多普勒超声为椎动脉型颈椎病提供了椎动脉形态学及血流动力学改变的依据。     

Influence of left ventricular size and hemodynamics on the systolic longitudinal myocardial Doppler velocity response to stress

Background Systolic myocardial Doppler velocity accurately identifies coronary artery disease. However, these velocities may be affected by age, hemodynamic responses to stress, and left ventricular cavity size. We sought to examine the influences of these variables on myocardial velocity during dobutamine stress in patients with normal wall motion. Methods One hundred seventy-nine consecutive patients with normal dobutamine echocardiograms were studied. Color myocardial tissue Doppler data were obtained at rest and peak stress, and peak systolic myocardial velocity (PSV) was measured in all basal and midventricular segments. Velocities at rest and peak stress were compared with left ventricular diastolic and systolic volumes, blood pressure, heart rate, and age by Pearson correlation and interdecile analysis by use of analysis of variance. Results The only clinical variable correlating with velocity was age; PSV showed only mild correlation with age at rest (r² = 0.01, P = .001) and peak stress (r² = 0.02, P = .001), but the normal peak velocity was significantly different between the extremes of age (<44 years and >74 years). There was very weak correlation of PSV with systolic and diastolic blood pressure (r² < 0.01), heart rate (r² < 0.01), systemic vascular resistance (r² = 0.08), and left ventricular volumes (r² < 0.01). Conclusions Peak systolic velocity during dobutamine stress is relatively independent of hemodynamic factors and left ventricular cavity size. The extremes of age may influence peak systolic Doppler velocities. These results suggest that peak systolic velocity may be a robust quantitative measure during dobutamine echocardiography across most patient subgroups. (Am Heart J 2002;143:169-75.)     

椎动脉闭塞类型及其代偿性血流动力学变化对后循环缺血的影响

目的通过彩色多普勒血流显像与经颅彩色多普勒超声联合检测评价椎动脉闭塞的类型、代偿性血流动力学变化与后循环缺血的相关性。方法回顾性纳入2015年6月至2016年6月经血管超声、DSA或CT血管成像(CTA)证实的椎动脉闭塞患者108例,根据MR扩散加权成像(DWI)结果,分为后循环梗死组(78例)和无后循环梗死组(TIA组,30例),采用彩色多普勒血流显像和经颅彩色多普勒超声联合检查健侧椎动脉颅外段管径和双侧椎动脉颅外段、颅内段收缩期峰值流速(PSV)及舒张期末流速(EDV)。比较两组间椎动脉闭塞类型、侧支循环建立、健侧椎动脉血流动力学变化的差异性。结果梗死组与TIA组单支椎动脉闭塞者分别为69例(88.5%)、26例(86.7%),双支椎动脉闭塞者分别为9例(11.5%)、4例(13.3%),组间椎动脉闭塞支数差异无统计学意义(χ~2=0.000,P=1.000)。梗死组的椎动脉颅内段闭塞者比例高于TIA组[70.5%(55/78)比36.7%(11/30);χ~2=10.444,P=0.001],侧支循环建立者比例低于TIA组[14.1%(11/78)比43.3%(13/30);χ~2=10.711,P=0.001]。TIA组单支椎动脉闭塞患者的健侧椎动脉颅外段PSV、EDV均高于梗死组[(65±21)cm/s比(57±15)cm/s;(25±8)cm/s比(20±7)cm/s;t值分别为2.043、2.606,均P0.05]。结论椎动脉闭塞后侧支循环的建立和健侧椎动脉的血流动力学代偿可改善后循环缺血的发生情况。     

Relation between symptoms and profiles of coronary artery blood flow velocities in patients with aortic valve stenosis: a study using transoesophageal Doppler echocardiography.

OBJECTIVE: To analyse profiles of coronary artery flow velocity at rest in patients with aortic stenosis and to determine whether changes of the coronary artery flow velocities are related to symptoms in patients with aortic stenosis. DESIGN: A prospective study investigating the significance of aortic valve area, pressure gradient across the aortic valve, systolic left ventricular wall stress index, ejection fraction, and left ventricular mass index in the coronary flow velocity profile of aortic stenosis; and comparing flow velocity profiles between symptomatic and asymptomatic patients with aortic stenosis using transoesophageal Doppler echocardiography to obtain coronary artery flow velocities of the left anterior descending coronary artery. SETTING: Tertiary referral cardiac centre. PATIENTS: Fifty eight patients with aortic stenosis and 15 controls with normal coronary arteries. RESULTS: Adequate recordings of the profile of coronary artery flow velocities were obtained in 46 patients (79%). Left ventricular wall stress was the only significant haemodynamic variable for determining peak systolic velocity (r = -0.83, F = 88.5, P < 0.001). The pressure gradient across the aortic valve was the only contributor for explaining peak diastolic velocity (r = 0.56, F = 20.9, P < 0.001). Controls and asymptomatic patients with aortic stenosis (n = 12) did not differ for peak systolic velocity [32.8 (SEM 9.7) v 27.0 (8.7) cm/s, NS] and peak diastolic velocity [58.3 (18.7) v 61.9 (13.5) cm/s, NS]. In contrast, patients with angina (n = 12) or syncope (n = 8) had lower peak systolic velocities and higher peak diastolic velocities than asymptomatic patients (P < 0.01). Peak systolic and diastolic velocities were -7.7 (22.5) cm/s and 81.7 (17.6) cm/s for patients with angina, and -19.5 (22.3) cm/s and 94.0 (20.9) cm/s for patients with syncope. Asymptomatic patients and patients with dyspnoea (n = 14) did not differ. CONCLUSIONS: Increased pressure gradient across the aortic valve and enhanced systolic wall stress result in characteristic changes of the profile of coronary flow velocities in patients with aortic stenosis. Decreased or reversed systolic flow velocities are compensated by enhanced diastolic flow velocities, particularly in patients with angina and syncope. This characteristic pattern of the profile of coronary artery flow velocities in patients with angina or syncope may be useful for differentiating those patients from asymptomatic patients.     

Evaluation of pulmonary arterial pressure by Doppler colour flow mapping in patients with a ductus arteriosus.

Blood flow in the pulmonary artery was studied by Doppler colour flow mapping and cardiac catheterisation in 19 patients with a ductus arteriosus and different pulmonary artery pressures. In the four patients with normal pulmonary artery pressures colour Doppler flow mapping showed multicoloured wide and long systolic and diastolic jets in the pulmonary artery. In the 15 patients with raised pulmonary arterial pressure the systolic jets varied from multicoloured to red and were thinner: in patients with considerably raised pulmonary arterial pressure the jets became redder during diastole. The Doppler velocity tracings showed that in patients with normal pulmonary artery pressures the mean peak systolic velocity was higher than the mean end diastolic velocity--so that in all four the ratio of peak systolic velocity to end diastolic velocity was less than 2. The mean peak systolic velocity was much higher than the mean end diastolic velocity in 13 of the 15 patients with raised pulmonary artery pressure; this meant that the ratio of peak systolic velocity to end diastolic velocity was greater than 2 in 10 of 11 patients. The end diastolic velocity was significantly lower in those patients with raised pulmonary artery pressure than in those with normal artery pressure. There was an inverse linear correlation between the mean pulmonary artery pressure and end diastolic ductal jet velocity in 17 of the 19 patients. Colour flow mapping and this quantitative Doppler technique can detect pulmonary artery hypertension in patients with a ductus arteriosus.     

慢性进展性大脑中动脉主干闭塞的神经影像和脑血流

目的 探讨慢性进展性大脑中动脉主干闭塞患者的临床、神经影像和脑血流动力学改变.方法 对75例大脑中动脉主干闭塞患者行头颅核磁共振成像、CT和经颅多普勒超声检测.结果 65例（86.7%）出现脑缺血症状及体征.70例（93.3%）头颅核磁共振或CT显示不同类型脑梗死,最常见的是低灌注分水岭梗死和腔隙性脑梗死.60例（80.0%）闭塞侧大脑中动脉深度范围血流速度明显降低,70例（93.3%）闭塞侧大脑前动脉血流速度代偿性增快,45例（60.0%）闭塞侧大脑后动脉血流速度代偿性增快.结论 经颅多普勒超声和神经影像学检查有助于评估慢性进展性大脑中动脉主干闭塞患者的病情发展和预后,为了解颅内侧支循环代偿状况和更深入研究缺血性脑血管病的发病机制提供客观依据.