脑小血管病总负荷与脑血流动力学指标的相关性  

Correlation analysis of total cerebral small vessel disease burden and cerebral hemodynamic indices

作　　者：陈珺茹 高庆春[1] 钟嘉仪 黄乐恩 CHEN Junru;GAO Qingchun;ZHONG Jiayi;HUANG Le'en(Department of Neurology,the Second Affiliated Hospital of Guang-zhou Medical University,Guangzhou 510000,China)

机构地区：[1]广州医科大学附属第二医院神经内科,广州510000 [2]中山大学公共卫生学院

出　　处：《中国神经精神疾病杂志》2022年第6期328-333,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金(编号:81371573);广州市临床特色技术项目(编号:0F02008)。

摘　　要：目的观察脑小血管病(cerebral small vessel disease,CSVD)总负荷与以临界关闭压(critical closing pressure,CCP)为中心的脑血流动力学指标之间的关联,探讨以CCP为中心的脑血流动力学指标能否反映脑小血管病变的严重程度。方法连续纳入CSVD患者,收集入组患者的一般资料,行CSVD总负荷评分,根据评分结果分为轻度组、中度组和重度组。使用TCD同步测定双侧大脑中动脉(middle cerebral artery,MCA)血流速度和动脉血压,计算以CCP为中心的脑血流动力学指标。分析不同程度的CSVD总负荷与脑血流动力学指标的相关性。结果本研究共入组92例CSVD患者,轻度组54例,中度组26例,重度组12例。三组间CCP(F=7.368,P=0.001)、收缩压(F=5.510,P=0.001)、平均动脉压(F=4.894,P=0003),差异具有统计学意义。CSVD总负荷与CCP(r=0.365,P<0.001)、收缩压(r=0.348,P=0.013)、平均动脉压(r=0.258,P=0.013)呈正相关。logistic回归结果显示,CSVD总负荷与CCP显著相关(OR=1.070,P=0.006)。结论CSVD患者的脑血流动力学改变为CCP、收缩压以及平均动脉压水平升高,以CCP为中心的脑血流动力学指标可以反映CSVD患者脑自动调节(cerebral autoregulation,CA)受损,并且可以反映脑小血管病变的严重程度。Objective To examine the association between total cerebral small vessel disease(CSVD)burden and cerebral hemodynamic indexes centered on critical closing pressure(CCP),and to investigate whether cerebral hemodynamic indexes centered on CCP can reflect the severity of cerebral small vessel disease.Methods Patients with CSVD were consecutively included,and general information of the enrolled patients was collected,and the total CSVD burden scores was performed,and the group was divided into mild,moderate and severe groups according to the score results.Cerebral hemodynamic indices centered on CCP were calculated using simultaneous measurement of bilateral middle cerebral artery(MCA)blood flow velocity and arterial blood pressure using TCD.The correlation between total CSVD burden scores and cerebral hemodynamic indices was analyzed.Results A total of 92 patients with CSVD were enrolled in this study,including 54 in the mild group,26 in the moderate group,and 12 in the severe group.The differences were statistically significant in CCP(F=7.368,P=0.001),systolic blood pressure(F=5.510,P=0.001),and mean arterial blood pressure(F=4.894,P=0003)among the three groups.Total CSVD burden was positively correlated with CCP(r=0.365,P<0.001),systolic blood pressure(r=0.348,P=0.013),and mean arterial blood pressure(r=0.258,P=0.013)were positively correlated.Logistic regression results showed that total CSVD burden was significantly correlated with CCP(OR=1.070,P=0.006).Conclusions Cerebral hemodynamic changes in CSVD patients are elevated levels of CCP,systolic blood pressure,and mean arterial blood pressure.Cerebral hemodynamic indices centered on CCP can reflect cerebral autoregulation(CA)impairment in CSVD patients and can reflect the severity of cerebral small vessel lesions.

关 键 词：经颅多普勒 临界关闭压 脑自动调节 脑血流动力学 脑小血管病总负荷 

分 类 号：R743[医药卫生—神经病学与精神病学]