右向左分流患者的脑血流自动调节受损:偏头痛和隐源性卒中的潜在机制  

Compromised Dynamic Cerebral Autoregulation in Patients with a Right-to-Left Shunt: a Potential Mechanism of Migraine and Cryptogenic Stroke

作　　者：郭珍妮[1] 邢英琦[2] 刘嘉[3] 王爽[1] 闫硕[1] 靳航[1] 杨弋[1] 吕珊[1] 郭雨竹 

机构地区：[1]吉林大学第一医院神经内科,长春130021 [2]吉林大学第一医院神经血管超声中心 [3]中国科学院深圳先进技术研究院

出　　处：《中国卒中杂志》2016年第4期288-294,共7页Chinese Journal of Stroke

摘　　要：目的右向左分流(right-to-left shunts,RLS)与偏头痛和隐源性卒中之间的关系目前尚未明确。动态脑血流自动调节(dynamic cerebral autoregulation,d CA)受损可能在偏头痛和隐源性卒中的发生发展过程中起着重要的作用,本研究旨在探讨RLS是否与d CA受损有关。方法本研究共纳入66例偏头痛患者,其中36例无RLS,30例有RLS。采用经颅多普勒超声连续监测患者的脑血流速度,同时采用无创手指血压连续监测仪实时同步监测动脉血压。利用传递函数分析得出以下脑血流自动调节参数:增益、相位差(phase difference,PD)和自动调节指数(autoregulation index,ARI)。结果 RLS组偏头痛患者的PD为50.6°±22.9°,明显低于无RLS组(67.2°±18.2°,P<0.001)。大量分流组的PD(45.4°±22.6°)明显低于少量分流组(64.9°±17.1°,P<0.01)和无RLS组(P<0.001);然而,少量分流组与无RLS组的PD值差异无显著性。RLS固有分流组的PD值(48.8°±19.9°)与潜在分流组(52.6°±26.1°)差异无显著性,但都明显低于无RLS组(P<0.05)。ARI结果与PD一致。结论伴有大量RLS的偏头痛患者d CA受损,这也许是联系RLS、偏头痛和隐源性卒中的潜在机制。Objective The relationship between right-to-left shunts（RLS） and migraine and cryptogenic stroke is not well understood. In this study, we investigated whether RLS are associated with impairment of dynamic cerebral autoregulation（d CA）, which may play a role in migraine and cryptogenic stroke.Methods Sixty-six migraineurs were enrolled in the study, including 36 non-RLS patients and 30 RLS patients. Non-invasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously from each patient by using transcranial Doppler and servo-controlled plethysmograph, respectively. Transfer function analysis was applied to derive autoregulatory parameters of gain, phase difference（PD）, and autoregulation index.Results The PD in migraineurs with RLS was 50.6？±22.9？, which was signifi cantly lower than that observed in the non-RLS group（67.2？±18.2？, P 0.001）. The PD in the large RLS group（45.4？±22.6？） was signifi cantly lower than that of the small RLS group（64.9？±17.1？, P 0.01） and non-RLS group（P 0.001）; however, the PD in the small RLS group was similar to that of the non-RLS group. The PD in the permanent group（48.8？±19.9？） was similar to that of the latent group（52.6？±26.1？）, and both were signifi cantly lower than that of the non-RLS group（P 0.05）. The autoregulation index results were similar to the PD fi ndings.Conclusion d CA is impaired in migraineurs with large RLS, and this may represent a potential mechanism linking RLS, migraine, and cryptogenic stroke.

关 键 词：脑血流自动调节 偏头痛 右向左分流 隐源性卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]