摘要： 目的 比较磁共振血管造影（MRA）改良脑梗死溶栓血流分级（m-TICI）与经颅多普勒超声（TCD）脑缺血溶栓血流分级（TIBI）对静脉溶栓后血管再通评价的一致性，并探讨其临床应用价值。方法 选择重组组织型纤溶酶原激活物阿替普酶静脉溶栓治疗大脑中动脉主干、基底动脉狭窄或闭塞的急性缺血性卒中患者共61 例，分别于溶栓治疗前、治疗后24 h 进行MRA 和TCD 检查，并验证m-TICI 和TIBI 分级系统对血管闭塞和再通评价结果的一致性。结果 溶栓治疗前m-TICI 和TIBI 分级分别显示血管闭塞者为49 例（80.33%）和45 例（73.77%；κ = 0.816，P = 0.000）；溶栓治疗后24 h，m-TICI和TIBI分级显示闭塞动脉完全再通者为9 例（14.75%）和11 例（18.03%）、部分再通者为18 例（29.51%）和17 例（27.87%），血管再通总数（包括完全再通和部分再通）分别为27 例（44.26%）和28 例（45.90%；κ = 0.917，P = 0.000）。结论 TCD TIBI分级系统与MRA m-TICI分级系统对急性缺血性卒中患者溶栓治疗前大动脉血管狭窄或闭塞的诊断和溶栓治疗后血管再通的评价，具有较高的一致性，二者相比，前者更具有检查灵活、方便、经济、可重复施行及床旁长时间监测等优势，值得进一步深入研究，以促进其在溶栓治疗过程中的广泛应用。

关键词: 超声检查, 多普勒, 经颅, 磁共振血管造影术, 组织型纤溶酶原激活物, 脑缺血, 动脉闭塞性疾病, 大脑中动脉, 基底动脉, 对比研究

Abstract: Objective To evaluate the accuracy and clinical diagnostic values of thrombolysis in brain ischemia (TIBI) grade system of transcranial Doppler ultrasomography (TCD) in assessing the situation of recanalization after thrombolytic therapy with modified thrombolysis in cerebral infarction (m-TICI) grade system of MRA as reference.  Methods  Select 61 acute ischemic stroke patients with middle cerebral artery (MCA), basilar artery (BA) stenosis or occlusion receiving thrombolytic therapy with alteplase. The patients underwent MRA and TCD examination before and after 24 h thrombolysis. Use m-TICI and TIBI grade system to evaluate the rate of occlusion and recanalization of target artery and test the consistency of two systems on recanalization evaluation. Results Before thrombolytic therapy, m-TICI grade showed artery occlusion in 49 cases (80.33% ) and TIBI grade displayed artery occlusion in 45 cases (73.77% ), indicating high consistency statistically (κ = 0.816, P = 0.000). Twenty-four hours after thrombolytic therapy, m-TICI and TIBI grade showed complete recanalization in 9 cases (14.75%) and 11 cases (18.03%), partial recanalization in 18 cases (29.51% ) and 17 cases (27.87% ) respectively, showing high statistical consistency. The comprehensive evaluation of m-TICI and TIBI grade system revealed total recanalization in 27 cases (44.26%) and 28 cases (45.90%), showing high statistical consistency (κ = 0.917, P = 0.000).  Conclusion The TIBI grade system of TCD has high consistency in diagnosing artery stenosis or occlusion and evaluating vascular recanalization in acute ischemic stroke patients with thrombolytic therapy compared with m-TICI grade system of MRA examination. TCD examination is flexible, convenient, economical, repeatable and can give bedside long monitoring, so it is worthy of further in-depth research, in order to promote its application in thrombolytic treatment process.

Key words: Ultrasonography, Doppler, transcranial, Magnetic resonance angiography, Tissue plasminogen activator, Brain ischemia, Arterial occulsive diseases, Middle cerebral artery, Basilar artery, Comp study