癫痫患者动态脑血流自动调节功能研究

Compromised Dynamic Cerebral Autoregulation in Patients with Epilepsy

目的探究癫痫患者的dCA功能。方法研究纳入100例癫痫患者和100例年龄、性别相匹配的健康志愿者作为对照组,分别测定其dCA功能。采用TCD联合无创指尖血压监测法分别连续采集受试者双侧MCA脑血流速度(cerebral blood flow velocity,CBFV)和动脉血压(arterial blood pressure,ABP)信号。将采集的CBFV和ABP信号经过传递函数法(transfer function analysis,TFA)分析,得出dCA参数(相位差和增益)。结果癫痫患者的总体相位差显著低于正常对照组(P=0.046),提示其dCA功能受损。此外,合并发作间期慢波的患者其相位差更低(P=0.012),dCA功能受损更明显。EEG表现为局灶性放电的患者与表现为多灶性放电的患者的相位差无显著性差异。同样,在EEG表现为单侧放电的患者中,其放电侧大脑半球与放电对侧大脑半球的相位差也无显著性差异。通过单因素和多因素回归模型分析临床因素与dCA参数的关系,发现发作间期慢波与相位差受损独立相关(P=0.016)。结论癫痫患者的dCA功能受损,而痫样放电合并发作间期慢波患者dCA受损更明显。dCA功能与癫痫患者的放电类型、放电部位无关。发作间期慢波是癫痫患者dCA功能受损的独立预测因素。

Objective The aim of this study is to analyze dCA in patients with epilepsy.Methods One hundred patients with epilepsy and 100 age-and sex-matched healthy controls were recruited.Noninvasive continuous cerebral blood flow velocity of the bilateral middle artery and arterial blood pressure were recorded.Transfer function analyses were used to analyze the autoregulatory parameters(phase difference and gain).Results The overall phase difference of patients with epilepsy was significantly lower than that of the healthy control group(P=0.046).Furthermore,patients with interictal slow wave had significant lower phase difference than the slow-wave-free patients(P=0.012).There was no difference in overall phase between focal discharges and multifocal discharges in patients with epilepsy.Simultaneously,there was no difference in mean phase between the affected and unaffected hemispheres in patients with unilateral discharges.In particular,interictal slow wave was an independent factor that influenced phase difference in patients with epilepsy(P=0.016).Conclusions Our study documented that dCA is impaired in patients with epilepsy,especially in those with interictal slow wave.The impairment of dCA occurs irrespective of the discharge location and type.Interictal slow wave is an independent factor to predict impaired dCA in patients with epilepsy.