特发性高颅压患者脑血流自动调节研究

Cerebral Blood Flow Autoregulation Assessment in Patients with Idiopathic Intracranial Hypertension

目的分析特发性颅内压增高(idiopathic intracranial hypertension,IIH)患者脑血流自动调节机能。方法连续入组2018年12月-2019年3月在首都医科大学附属北京天坛医院就诊的IIH患者,并选取年龄匹配的健康志愿者作为对照组。应用传递函数的算法分析TCD显示的大脑中动脉血流速度及动脉血压的自然波动以评估脑血流自动调节机能。结果入组IIH组10例,对照组13例。所有入组者均完成了双侧大脑半球的脑血流自动调节检测,共检测了20个高颅压半球及26个正常对照半球。与对照组相比,IIH组大脑中动脉脑血流增益显著降低[(0.64±0.35)%/%vs(0.37%±0.20)%/%,P=0.004];相位也显著降低(58.80±20.86°vs 39.16±23.79°,P=0.005),差异有统计学意义。IIH组每秒钟脑血流速度的恢复率较对照更低,但差异尚未达到统计学意义[(26.34±43.29)%/s vs(38.81±20.16)%/s,P=0.240]。结论IIH患者脑血流自动调节机能显著受损。

Objective To investigate the capacity of cerebral blood flow autoregulation in patients with idiopathic intracranial hypertension(IIH).Methods This study consecutively enrolled patients with IIH from Beijing Tiantan Hospital,Capital Medical University and age-matched health volunteers as control from December 2018 to March 2019.The spontaneous fluctuation in arterial blood pressure and cerebral blood flow velocity were analyzed using transfer function analysis to assess cerebral blood flow autoregulation.Results A total of 10 patients with IIH and 13 control subjects were included.46 middle cerebral arteries(MCAs)were detected,including 20 MCAs in cerebral hemisphere with high cranial pressure and 26 normal ones.Compared to control group,MCA blood flow in IIH group decreased significantly[(0.64±0.35)%/%vs(0.37±0.20)%/%,P=0.004],the phase of cerebral blood flow in IIH group also declined significantly(58.80±20.86°vs 39.16±23.79°,P=0.005).The rate of cerebral blood flow recovery per second in IIH group was lower than that in control group,but without statistical significance[(26.34±43.29)%/s vs(38.81±20.16)%/s,P=0.240].Conclusions Cerebral blood flow autoregulation in patients with IIH was significantly impaired.