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作者	单位	E-mail
谭丽梅	秦皇岛市第一医院神经内科河北秦皇岛 066000	tlmxiaotan@126.com
兰希发	秦皇岛市第一医院神经内科河北秦皇岛 066000
韩慧儒	秦皇岛市第一医院神经内科河北秦皇岛 066000
李佳佳	秦皇岛市第一医院神经内科河北秦皇岛 066000
祖艳颖	秦皇岛市第一医院神经内科河北秦皇岛 066000

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中文摘要:

摘要目的：分析经颅多普勒血流动力学定量参数预测青年脑卒中患者预后的价值。方法：病例纳入时间为2018年4月至2022年12月，来源于秦皇岛市第一医院，研究对象为349例青年脑卒中患者，将之作为病例组，根据病情严重程度分为轻、中和重度组，例数分别为97、196例、56例，根据预后情况分为预后不良组和预后良好组，例数分别为27、322例，另选同期358名健康体检青年人群作为对照组。比较病例组与对照组、不同病情严重程度及不同预后患者的血流动力学定量参数，分析血流动力学定量参数与患者、预后的相关性及对患者预后的预测价值。结果：与对照组比较，病例组大脑中动脉搏动指数（PI）更高，平均血流速度（Vm）、收缩期血流速度（Vs）、舒张期血流速度（Vd）、屏气指数（BHI）、脑局部血流量丧失指数（r CBFLI）更低（P<0.05）。重度组大脑中动脉PI高于中度组、轻度组（P<0.05），中度组高于轻度组（P<0.05）；重度组大脑中动脉Vm、Vs、Vd、BHI、r CBFLI低于中度组、轻度组（P<0.05），中度组低于轻度组（P<0.05）。预后不良组大脑中动脉PI高于预后良好组（P<0.05），大脑中动脉BHI、r CBFLI低于预后良好组（P<0.05）。大脑中动脉PI与青年脑卒中患者病情严重程度、预后呈正相关（P<0.05）；大脑中动脉Vm、Vs、Vd、BHI、r CBFLI与青年脑卒中患者病情严重程度呈负相关（P<0.05）；大脑中动脉BHI、r CBFLI与青年脑卒中患者预后呈负相关（P<0.05）。大脑中动脉PI、BHI、r CBFLI联合检测的曲线下面积（AUC）值为0.864，高于大脑中动脉PI、BHI、r CBFLI单独检测（0.698、0.737、0.782，P<0.05）；大脑中动脉BHI、联合检测的敏感度分别为85.19%、81.48%，高于大脑中动脉PI、r CBFLI单独检测（66.67%、62.96%，P<0.05）；大脑中动脉r CBFLI、联合检测的特异度分别为81.68%、78.26%，高于大脑中动脉PI、BHI单独检测（64.29%、67.08%，P<0.05）。结论：青年脑卒中患者PI偏高，Vm、Vs、Vd、BHI、r CBFLI偏低，且PI随患者病情的加重而升高，Vm、Vs、Vd、BHI、r CBFLI随患者病情的加重而降低，另PI、BHI、r CBFLI可评估患者预后情况，三者联合检测对青年脑卒中患者预后的预测价值更高。

英文摘要:

ABSTRACT Objective: Analyzing the value of quantitative transcranial doppler hemodynamic parameters in predicting prognosis in young stroke patients. Methods: Cases were included from April 2018 to December 2022, originating from the First Hospital of Qinhuangdao City, and the study population consisted of 349 young stroke patients, which were treated as a case group, according to disease, they were divided into mild, moderate and severe groups, with the numbers of cases being 97, 196, and 56, and according to the prognosis, they were divided into poor prognosis and good prognosis groups, with the numbers of cases being 27 and 322. 358 healthy young people as the control. The hemodynamic quantitative parameters were compared between the case and control group, patients with different severity of disease and different prognosis. The correlation and predictive value between hemodynamic quantitative parameters and the severity of disease and prognosis of patients were analyzed. Results: Compared to the control, PI of middle cerebral artery in case group was higher, Vm, Vs, Vd, BHI and rCBFLI were lower (P<0.05). PI in the severe was higher than moderate and mild group (P<0.05), moderate was higher than mild group (P<0.05). Vm, Vs, Vd, BHI, rCBFLI of the severe were lower than moderate and mild group (P<0.05), moderate were lower than mild group (P<0.05). PI of MCA in the poor prognosis was higher than good prognosis group (P<0.05), BHI and rCBFLI of MCA in the poor prognosis were lower than good prognosis group (P<0.05). PI was positively correlated with the severity and prognosis of patients (P<0.05). Vm, Vs, Vd, BHI, rCBFLI of MCA were negatively correlated with the severity of patients (P<0.05). BHI and rCBFLI of middle cerebral artery were negatively correlated with the prognosis of patients (P<0.05). The AUC value of combined detection of PI, BHI and rCBFLI in predicting the prognosis of young stroke patients was 0.864, higher than PI, BHI and rCBFLI alone (0.698, 0.737, 0.782, P<0.05). The sensitivity of middle cerebral artery BHI and combined detection were 85.19% and 81.48% respectively, which were higher than that of middle cerebral artery PI and rCBFLI alone (66.67% and 62.96%, P<0.05). The specificity of rCBFLI and combined detection of MCA was 81.68% and 78.26% respectively, which was higher than that of PI and BHI alone (64.29% and 67.08%, P<0.05). Conclusion: PI was higher and Vm, Vs, Vd, BHI, rCBFLI were lower in young patients with stroke, and PI increased with the aggravation of the patient's condition, while Vm, Vs, Vd, BHI, rCBFLI decreased with the aggravation of the patient's condition. PI, BHI, rCBFLI could be used to evaluate the prognosis of the patients, and the combined detection of the three had higher predictive value.

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