摘要： 目的 应用经颅多普勒超声技术探讨大脑中动脉急性闭塞或狭窄后重组组织型纤溶酶原激活物阿替普酶静脉溶栓治疗前后血流分级变化，以及与神经功能缺损程度及预后之间的相关关系。方法 分别于阿替普酶静脉溶栓治疗前和溶栓治疗后24 h 对狭窄或闭塞的大脑中动脉进行脑缺血溶栓血流（TIBI）分级。采用美国国立卫生研究院卒中量表（NIHSS）和改良Rankin 量表（mRS）评价溶栓治疗后24 h 大脑中动脉TIBI 分级与NIHSS 和mRS 评分之间的相关性。结果 溶栓治疗前不同TIBI 分级之间NIHSS 评分差异有统计学意义（H = 36.514, P = 0.000），并且TIBI分级与NIHSS 评分呈负相关关系（r_s = -0.737, P = 0.000）。与溶栓治疗前相比，溶栓治疗后24 h 约47.17%（25/53）患者TIBI 分级改善至4 ~ 5 级（Z = 5.262, P = 0.000）；神经功能恢复良好者71.70%（38/53）、不良者28.30%（15/53；Z = -6.353，P = 0.000）。溶栓治疗后第90 天时，mRS 评分提示疗效良好者67.92%（36/53）、疗效不良者32.08%（17/53），不同TIBI 分级之间mRS 评分差异有统计学意义（χ² = 31.973, P = 0.000），二者之间呈负相关（r_s = -0.683, P = 0.001）。结论 阿替普酶静脉溶栓治疗后，TIBI 血流分级与大脑中动脉急性闭塞或狭窄患者神经功能缺损程度及其恢复程度相关，能够反映溶栓治疗效果并有助于判断预后。

关键词: 超声检查, 多普勒, 彩色, 动脉闭塞性疾病, 大脑中动脉, 脑缺血, 血栓溶解疗法, 组织型纤溶酶原激活物

Abstract: Objective  To investigate the relationship between changes of blood flow of acute middle cerebral artery (MCA) occlusion or stenosis and degree of neural function defect and prognosis before and after intravenous thrombolytic therapy with alteplase.  Methods  Fifty-three patients diagnosed as acute MCA stenosis or occlusion and given alteplase intravenous thrombolysis therapy were enrolled. Thrombolysis in brain ischemia (TIBI) flow grades of MCA before and 24 h after the thrombolysis were assessed. The correlation between TIBI flow grades and National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores 90 d after the thrombolysis was evaluated.  Results  There were significant differences in the NIHSS scores before intravenous thrombolytic therapy among different TIBI flow grades (H = 36.514, P = 0.000). The TIBI flow grade was negatively correlated with the NIHSS scores before thrombolysis (r_s = -0.737, P = 0.000), indicating that lower TIBI grade of MCA presented the nerve function defect worse. Compared with before thrombolytic therapy, there were 25 cases (47.17% ) achieved to grade 4-5 of TIBI flow grade of MCA 24 h after thrombolytic therapy, suggesting the recanalization of MCA (Z = 5.262, P = 0.000). In comparision with pre-thrombolytic therapy, neural function of 38 cases (71.70% ) recovered well 24 h after treatment, and the difference of NIHSS scores was statistically significant while that of 15 cases (28.30%) did not obtain favorable recovery of neural function (Z = -6.353, P = 0.000). There were significant differences in mRS scores 90 d after the thrombolysis among different TIBI flow grades 24 h after the thrombolysis (χ² = 31.973, P = 0.000), and they were negatively correlated with each other (r_s = -0.683, P = 0.001). According to mRS scores, 36 cases (67.92%) obtained favorable outcome but 17 cases (32.08%) was unfavorable 90 d after the therapy.  Conclusion  TIBI flow grade is correlated with neurological deficit and its recovery in acute MCA occlusion or stenosis, which may reflect the efficacy of thrombolytic therapy and help to predict the prognosis.

Key words: Ultrasonography, Doppler, color, Arterial occulsive diseases, Middle cerebral artery, Brain ischemia, Thrombolytic therapy, Tissue plasminogen activator