摘要
目的 通过经颅超声多普勒 (TCD)检测 ,了解系统性红斑狼疮 (SLE)患儿的脑血流情况并探讨其与狼疮脑病的关系。方法 对 1993— 1999年北京儿童医院SLE住院患儿 38例 (男 5例 ,女 33例 ,平均年龄 10 7岁 )进行了TCD检查 ,其中诊断为狼疮脑病者 15例。TCD探查范围包括 :双侧颈内动脉颅外段、颅内段 ;双侧大脑半球血管 :大脑前、中、后动脉 ,颈内动脉终末段 ;椎 基底动脉。对血流速度、血管搏动指数、频谱形态、血流声频等指标进行分析。 3例患儿于病程不同时期进行了动态TCD检查。结果 38例中TCD基本正常者 11例 ,其余 2 7例 (71% )存在不同程度异常改变。其中以广泛的扩张性、低搏动性改变最为多见 (14例 ) ;5例表现高流速、低搏动性血流动力学特点。血液流速异常者 19例 (5 0 % ) :9例 (2 3 7% )为单侧或双侧血管血流速度增高 ,7例 (18 4% )流速减低 ,3例 (7 9% )表现左右半球血管流速不对称 ;血管搏动指数降低者有 2 0例 (5 2 6 % ) ;13例(34 2 % )可探及涡流频谱并伴有粗糙声频。χ2 检验显示 :合并脑病及未合并脑病者出现涡流的阳性率之间差异存在显著性 (P <0 0 5 )。结论 TCD检测结果与临床较为相符 ;涡流频谱的出现 ,对狼疮脑病的诊断有一定提示作用。有必要进一步作病例对照的前瞻性研?
Objective To investigate the cerebrovascular hemodynamics of SLE children by TCD and the relationship between abnormal findings of TCD and central nervous system (CNS) involvement.Method This retrospective analysis was conducted in 38 SLE patients.The mean age was 10 7 years (range 5～14 years) with a female to male ratio 33∶5.Bilateral internal carotid arteries extracranial and intracranial parts,anterior,medial and posterior cerebral arteries;basilar arteries and vertebral arteries were detected.The following parameters were measured including flow rate;pulsatility index (PI) and ultrasound spectrum.Three patients were checked up in different periods from disease onset.Result Abnormal findings were found in 27 patients (71%),abnormal flow rate in 19 patients (50%) including 9 increased and 7 decreased,and 3 with asymmetry flow rate,and PI decreased in 20 patients (52 6%).Vortex flow spectrum was found in 13 patients (34 2%).There were significant differences in the incidence rate of vortex flow between CNS involvement group and non CNS group.Conclusion TCD findings were consistent with the clinical change,activity and prognosis of the disease.The detection of vortex flow may be helpful to clinical diagnosis of CNS involvement in SLE patients.
关键词
经颅超声多普勒检查
系统性红斑狼疮
儿童
脑血
Ultrasonography,transcranial Doppler
Lupus erythematosus,systemic
Brain diseases
Child
