球囊闭塞试验反流压与基础血压的关系在颈部肿瘤中的应用价值

doi:10.3877/cma.j.issn.2095-5782.2021.04.006

中华介入放射学电子杂志 ›› 2021, Vol. 09 ›› Issue (04) : 383 -387. doi: 10.3877/cma.j.issn.2095-5782.2021.04.006

神经介入

球囊闭塞试验反流压与基础血压的关系在颈部肿瘤中的应用价值

刘录¹, 陈光利²^,^†(

), 梁熙虹³, 张靖⁴, 王征宇⁵, 李海波¹

^1. 510623　广东广州，广州市妇女儿童医疗中心介入&血管瘤科
^2. 100730　北京，北京中医药大学附属东直门医院介入科
^3. 100730　北京，首都医科大学附属北京同仁医院医学影像中心
^4. 510080　广东广州，广东省人民医院（广东省医学科学院）介入治疗科
^5. 201400　上海，南方医科大学附属上海市奉贤区中心医院介入科

收稿日期:2020-12-14 出版日期:2021-11-25
通信作者: 陈光利

The value of the relationship between regurgitant pressure and basal blood pressure in balloon occlusion test in patients with head and neck neoplasms

Lu Liu¹, Guangli Chen²^,^†(), Xihong Liang³, Jing Zhang⁴, Zhengyu Wang⁵, Haibo Li¹

^1. Department of Interventional Radiology & Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangdong Guangzhou 510623
^2. Department of Interventional Radiology, Dongzhimen Hospital Affiliated to Beijing University of Traditional Medicine, Beijing 100730
^3. Medical Imaging Center, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing 100730
^4. Department of Interventional Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Guangzhou 510080
^5. Department of Interventional Radiology, Shanghai Fengxian District Central Hospital Affiliated to Southern Medical University, Shanghai 201400, China

Received:2020-12-14 Published:2021-11-25
Corresponding author: Guangli Chen

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引用本文：

刘录, 陈光利, 梁熙虹, 张靖, 王征宇, 李海波. 球囊闭塞试验反流压与基础血压的关系在颈部肿瘤中的应用价值[J]. 中华介入放射学电子杂志, 2021, 09(04): 383-387.

Lu Liu, Guangli Chen, Xihong Liang, Jing Zhang, Zhengyu Wang, Haibo Li. The value of the relationship between regurgitant pressure and basal blood pressure in balloon occlusion test in patients with head and neck neoplasms[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(04): 383-387.

目的

探讨反流压与基础血压的比值与患者球囊闭塞试验中出现神经功能缺损是否存在关系；构建以反流压与基础血压比值定量评估一侧颈内动脉闭塞可行性的新方法。

方法

回顾性分析2015年5月至2018年3月在北京同仁医院耳鼻喉头颈外科住院进行球囊闭塞试验的患者73例，平均年龄46.4岁，其中男性37例，女性36例。术中采用美国国立卫生院卒中量表（NIHSS）评估分为症状阳性组共14例，阴性组59例；并测量反流压数据与基础血压。采用Logistic多因素回归分析各项反流压数据影响因素，采用独立样本t检验比较阳性组与阴性组间反流压及反流压比率有无差异，P < 0.05为有统计学意义。对于反流压比率的预判效能采用ROC曲线。

结果

反流压各项数据均与基础血压各项数据呈正相关性。以44.6%为收缩期反流压比率（SRPR）阈值时敏感度为100%，且ROC曲线下面积为0.965，以42.1%为平均反流率（MRPR）阈值时特异度为98%。

结论

以收缩期反流压比率（SRPR）评估一侧颈内动脉闭塞试验敏感度最高，以平均反流率（MRPR）评估特异度最高，且优于既往评价标准。

关键词: 脑血管造影, 球囊闭塞试验, 反流压

Objective

To investigate the relationship between the ratio of regurgitant pressure to basal blood pressure and neurological deficits in patients undergoing balloon occlusion test. To constructa new method to quantitatively evaluate the feasibility of unilateral internal carotid artery occlusion by the ratio of regurgitant pressure to baseline blood pressure.

Methods

A retrospective analysis was made on 73 patients who underwent balloon occlusion test from May 2015 to March 2018 in otolaryngology head and neck surgery department of Beijing Tongren Hospital. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the patients during the operation and were divided into symptomatic positive group and negative group. The data of regurgitant pressure and basic blood pressure were measured. Logistic multivariate regression analysis was used to analyze the influencing factors of regurgitant pressure data. independent sample t test was used to compare the difference of regurgitant pressure and regurgitant pressure ratio between positive and negative groups, P < 0.05. ROC curve is used to predict the effectiveness of regurgitant pressure ratio.

Results

The data of reflux pressure were positively correlated with the data of basic blood pressure. The sensitivity was 100% with 44.6% as the systolic reflux pressure ratio (srpr) threshold, the area under the ROC curve was 0.965, and the specificity was 98% with 42.1% as the mean reflux rate (mrpr) threshold.

Conclusions

The data of regurgitant pressure were positively correlated with the data of basic blood pressure. When the systolic regurgitant pressure ratio (SRPR) is less than 44.6%, or the diastolic regurgitant ratio (DRPR) is less than 49.3%, or the mean regurgitant pressure rate (MRPR) is less than 42.1%, the occlusion test is positive, which is better than the previous evaluation criteria.

Key words: Cerebral angiography, Balloon occlusion test, Regurgitant pressure

图1 患者，女，26岁，咽旁间隙副神经节瘤1A~1B：造影显示为左侧颅底区域肿瘤明显的染色，L-ICA轻度受压内移；1C~1D：左侧ICA压迫阻断后R-ICA、L-VA造影显示前后交通动脉开放良好及反流入R-ICA血液。

图2 患者，男，43岁，颈部副神经节瘤，充盈球囊闭塞左侧ICA2A~2B：左侧颈内动脉内充盈不可脱球囊，阻断L-ICA内血流；2C：球囊导管内少量注入对比剂，对比剂滞留，提示L-ICA完全阻断。

表1 SRP、MRP的影响因素

模型	标准系数		t值		P值
模型	SPR	MRP	SRP	MRP	SRP	MRP
身高	-0.120	0.118	-0.930	1.122	0.356	0.266
BMI	0.101	-0.054	0.910	-0.513	0.366	0.610
年龄	0.071	-0.188	-0.644	-1.536	0.522	0.129
MAP	0.493	0.874	1.794	3.579	0.077	0.001
SP	0.740	0.629	2.887	2.410	0.004	0.019

表1 SRP、MRP的影响因素

模型	标准系数		t值		P值
模型	SPR	MRP	SRP	MRP	SRP	MRP
身高	-0.120	0.118	-0.930	1.122	0.356	0.266
BMI	0.101	-0.054	0.910	-0.513	0.366	0.610
年龄	0.071	-0.188	-0.644	-1.536	0.522	0.129
MAP	0.493	0.874	1.794	3.579	0.077	0.001
SP	0.740	0.629	2.887	2.410	0.004	0.019

表2 阳性组、阴性组间差异

BOT	均值±标准差		均值差异	P值
BOT	阳性组	阴性组	均值差异	P值
SRP	45.8 ± 10.6	73.0 ± 18.3	-27.2	0.000
DRP	33.5 ± 9.1	52.4 ± 11.8	-18.9	0.000
MRP	37.6 ± 9.3	59.3 ± 13.6	-21.6	0.000
SRPR	0.31 ± 0.08	0.56 ± 0.12	-0.24	0.000
DRPR	0.43 ± 0.14	0.68 ± 0.12	-0.25	0.000
MRPR	0.37 ± 0.11	0.62 ± 0.12	-0.25	0.000

表2 阳性组、阴性组间差异

BOT	均值±标准差		均值差异	P值
BOT	阳性组	阴性组	均值差异	P值
SRP	45.8 ± 10.6	73.0 ± 18.3	-27.2	0.000
DRP	33.5 ± 9.1	52.4 ± 11.8	-18.9	0.000
MRP	37.6 ± 9.3	59.3 ± 13.6	-21.6	0.000
SRPR	0.31 ± 0.08	0.56 ± 0.12	-0.24	0.000
DRPR	0.43 ± 0.14	0.68 ± 0.12	-0.25	0.000
MRPR	0.37 ± 0.11	0.62 ± 0.12	-0.25	0.000

表3 诊断效能评价

项目	阈值	灵敏度（%）	特异度（%）	曲线下面积
SRP	≤ 58 mmHg	92	78	0.897
SRPR	≤ 44.6%	100	83	0.965
DRP	≤ 44 mmHg	85	78	0.823
DRPR	≤ 49.3%	78	95	0.913
MRP	≤ 49.3 mmHg	93	80	0.909
MRPR	≤ 42.1%	79	98	0.946

表3 诊断效能评价

项目	阈值	灵敏度（%）	特异度（%）	曲线下面积
SRP	≤ 58 mmHg	92	78	0.897
SRPR	≤ 44.6%	100	83	0.965
DRP	≤ 44 mmHg	85	78	0.823
DRPR	≤ 49.3%	78	95	0.913
MRP	≤ 49.3 mmHg	93	80	0.909
MRPR	≤ 42.1%	79	98	0.946

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