中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2019, Vol. 14 ›› Issue (8): 1412-1418.doi: 10.4103/1637-5374.251332

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

屏气指数可用于评价脑白质疏松症患者脑血管储备功能受损

  

  • 出版日期:2019-08-15 发布日期:2019-08-15

Assessment of cerebrovascular reserve impairment using the breath-holding index in patients with leukoaraiosis

Ying Bian 1, 2 , Jin-Chun Wang 2 , Feng Sun 2 , Zi-Yi Sun 3 , Yu-Jiao Lin 2 , Yang Liu 1 , Bin Zhao 2 , Li Liu 2 , Xiao-Guang Luo 1   

  1. 1 Department of Neurology, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
    2 Department of Neurology, the Fifth People’s Hospital of Shenyang, Shenyang, Liaoning Province, China
    3 Department of Endocrinology, Shengjing Hospital, China Medical University, Shenyang, Liaoning Province, China
  • Online:2019-08-15 Published:2019-08-15
  • Contact: Xiao-Guang Luo, MD, PhD, grace_shenyang@163.com.

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摘要：

许多研究表明脑白质疏松症与脑血管储备功能受损有关。然而，脑白质疏松确切的血流动力学改变尚不清楚，存在许多争议。1，试验采用经颅多普勒超声和屏气试验观察中国北方汉族人群症状性脑白质疏松症的动态血流动力学变化。(1)共纳入203例确诊为缺血性脑卒中或临床慢性进展性脑缺血症状的患者，年龄43-93岁，男97例，女106例。根据Fazekas分级标准评估脑白质疏松的严重程度，将患者分为4组，0，I，II，III级为无脑白质疏松、轻、中、重度脑白质疏松，各组分别为44，79，44，36例；(2)进行经颅多普勒超声检查和屏气试验，测量双侧大脑中动脉的平均血流速度，计算屏气指数发现，屏气指数与脑白质疏松症的严重程度呈负相关，与认知功能损害呈正相关；(3)屏气指数低的患者在蒙特利尔认知功能和执行功能检测中表现不佳，即屏气指数越低，MoCA、TMTA、TMTB评分越低；(4)上述数据表明，屏气指数是评价脑白质疏松症患者脑血管储备功能受损的一个有利参数。屏气指数可以反映认知功能障碍，为脑白质疏松症的病理生理学提供了新的视角。试验方案已经在中国临床试验注册中心注册(注册号：ChiCTR1800014421)。

orcid: 0000-0001-9828-0626 (Xiao-Guang Luo)

关键词: 脑血管小血管疾病, 白质高强度, 脑血流动力学, 脑灌注不足, 大脑中动脉, 血流速度, 屏气试验, 屏气指数, 认知功能, 神经再生

Abstract:

Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate he¬modynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43–93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoara¬iosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunc¬tion, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth People’s Hospital of China (approval No. 20160301). Written informed consent was obtained from each participant.  This trial has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).

Key words: nerve regeneration, cerebral small vascular disease, white matter hyperintensities, cerebral hemodynamics, cerebral hypoperfusion, middle cerebral artery, blood flow velocity, breath-holding test, breath-holding index, cognitive function, neural regeneration