| Background:Cerebrovascular disease (CVD) in elderly population in China is a common and frequently occurring disease, in recent years, CVD appears a rising and younger age trend, it has become the main diseases that endanger the health and life of the elderly in our country.The cerebral ischemic stroke (CIS) accounts for about70%among CVD, patients with multiple risk factors for CIS are individuals at high risk of stroke recurrence. There has not been an effective method for the treatment of cerebral ischemic stroke. Therefore, in order to make the stroke on the health hazards to a minimum, as soon as possible to evaluate and control risk factors for CIS to prevent occurrence of stroke, early detection of stroke etiology, accurate judgment on stroke patient’s condition, and a reasonable treatment to be given, have been paid close attention by the neurologist. Atherosclerosis (AS) is a major cause of cerebral ischemic stroke, in the early stage of atherosclerosis, vascular compliance (C) decreases, the vessels’ elasticity reduces, with the aggravation of the degree of atherosclerosis, C decreases. At present, the traditional examination methods of cerebral vascular applications such as digital subtraction angiography (DSA) computerized tomography angiography (CTA), magnetic resonance angiography (MRA), are relatively mature in the application of the aspect of vascular morphology, but can not be assessed on vascular function, and because the price is expensive and many contraindications, such traditional examination methods are not suitable to be operated repeatedly and as a routine screening method of VCD, so the clinical application of traditional examination methods is limited. Transcranial doppler ultrasound(TCD)as a non-invasive examination method is widely used in the diagnosis of CVD. Pulsatility index (PI) is an important parameter of TCD, by means of using PI to evaluate intracranial vascular C, PI may guide the diagnosis and treatment of CVD and may judge the severity and prognosis of CVD,witch attracts people’s more and more attention.Objective:Through the analysis of the relationship between middle cerebral artery (MCA) PI and CIS and its risk factors, to provide convenient, inexpensive, noninvasive and repeatable operation examination for clinical, as early as to detect changes of morphological structure and function of cerebral vascular, so as to guide the rational treatment and reverse the pathological process, to prevent the occurrence of stroke, to assess the severity of stroke, to guide the treatment of stroke and to judge prognosis of stroke.Method:In accordance with the diagnostic criteria formulated by2010neurology branch of Chinese Medical Association cerebral vascular disease group and guidelines of the diagnosis and treatment of acute ischemic stroke writing group, guidelines of diagnosis and treatment of acute ischemic stroke china,300cases of patients with cerebral infarction of middle cerebral artery have been confirmed by computerized tomography(CT) or magnetic resonance imaging(MRI), and acute cerebral infarction has been confirmed by diffusion weighted imaging(DWI), the course of disease2weeks. Eliminated the cases of hernia formation; Eliminated the cases of atrial fibrillation, valvular heart disease, acute coronary syndrome, blood disease, severe infection, liver and kidney dysfunction, autoimmune disease, malignant tumor, and the cases of taking folic acid, vitamin B and antiepileptic drug; Eliminated the cases of neck artery stenosis or occlusion by the neck vascular ultrasound; Eliminated the cases of arteriovenous malformation; Eliminated the cases of having poor temporal windows and being not conducive to the PI test; Eliminated the cases of having wide pulse pressure to effect PI value; Eliminated the cases of not coordinating the TCD examination; Eliminated the cases of not willing to make the test.PI of bilateral MCA was detected by means of TCD, the difference of PI value between infarction side(the affected side) and non infarction side (the contralateral) was observed; The infarctions whose infarction diameters less than1.5-2.Ocm were looked as lacunar infarct group, the infarctions whose infarction diameter greater than or equal to2.0cm were looked as large infarction group, the difference of PI value between lacunar infarction group and large infarction group was observed; Stroke risk factors were recorded, such as age, gender, smoking, alcohol drinking, BMI=height/weight (kg/m2), hypertension, diabetes mellitus, total cholerol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, homocysteine (HCY), fibrinogen (Fib), the average PI bilateral MCA were calculated, dependency and related degree between PI and CVD risk factors were observed.Result:1. Patients with middle cerebral artery territory acute cerebral infarction, middle cerebral artery PI values of the affected side are higher than the contralateral (P<0.05).2. Patients with middle cerebral artery territory acute cerebral infarction, middle cerebral artery PI values have not statistically significant differences between large infarction group and lacunar infarction group (P>0.05).3. Middle cerebral artery PI is related to age,BMI and Fib. Conclusion:1. Patients with middle cerebral artery territory acute cerebral infarction, middle cerebral artery PI values of the affected side are higher than the contralateral. Compared with the contralateral, in the affected side.vascular compliance and vascular elasticity obviously reduce and vascular resistance increases.2. Patients with middle cerebral artery territory acute cerebral infarction, middle cerebral artery PI values have not statistically significant differences between large infarction group and lacunar infarction group, macroangiopathy also exists in patients with lacunar infarction.3. The age, BMI and Fib are associated with middle cerebral artery PI. With the increase of age, BMI and Fib concentration, PI increases, vascular compliance decreases, the risk of ischemic stroke increases.4. Transcranial doppler ultrasound PI may be a predictor of cerebrovascular events, severity evaluation, treatment, prognosis and clinical detection means. |
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