颅内动脉狭窄的微栓塞与血流动力学研究

发布时间：2018-04-03 12:58

本文选题：烟雾病　切入点：脑栓塞　出处：《北京协和医学院》2014年博士论文

【摘要】：第一部分烟雾病患者微栓子信号预测未来脑缺血事件研究背景：烟雾病患者脑梗死一直被认为是由于血管狭窄引起的低灌注所致。然而,最近有研究显示,在烟雾病患者可以检测到微栓子信号(microembolic signals, MES)。这表明在烟雾病中有动脉到动脉的微栓塞发生。但是,MES在烟雾病患者脑梗死中的作用尚不明确。目的：探索MES在预测烟雾病患者未来脑缺血事件中的作用。方法：连续入组54例烟雾病患者。应用经颅多普勒超声(transcranial Doppler, TCD)监测入组患者双侧大脑中动脉30分钟。随访1年,记录主要终点事件：缺血性卒中及短暂性脑缺血发作(transient ischemic attack, TIA)的情况。结果：共有11(20.4%)例烟雾病患者患者监测到MES,占烟雾病半球数的10.2%。Logistic回归分析发现MES与烟雾病患者3个月内脑缺血症状有关(OR=4.41,95%CI1.11-17.59)。在中位时间384天的随访期间,共有14(13.0%)个半球发生脑缺血事件(7例缺血性卒中、7例TIA)。Cox生存分析显示,在调整了年龄、性别、缺血性卒中及TIA史、铃木分期以及血管重建术后,MES阳性半球发生缺血性卒中及TIA的风险是MES阴性半球的6.84倍(95%CI1.82-25.66),缺血性卒中的风险是阴性半球的10.61倍(95%CI1.66-67.70), 结论：烟雾病患者MES与近期脑缺血症状相关,而且MES是烟雾病患者未来脑缺血事件的独立预测因子。对烟雾病患者进行TCD微栓子监测或将有利于对患者更好的临床管理,亟待进一步研究。第二部分烟雾病脑血流自动调节机能研究背景：既往研究表明烟雾病患者的脑血流自动调节机能受损,有可能会增加其脑组织缺血及出血的风险。然而在烟雾病逐渐进展的过程中,我们尚不清楚自动调节这种重要的脑保护机制从何时开始受损,以及如何随疾病的进展而变化。目的：应用无创的新型方法研究烟雾病患者动态脑血流自动调节机能与烟雾病血管分期之间的关系。方法：连续入组13例经数字减影血管造影诊断为双侧烟雾病的患者及10例健康对照。应用改良铃木分期对入组的26个烟雾病半球进行血管分级。应用传递函数的算法分析大脑中动脉血流速度及动脉血压的自然波动以分析脑血流自动调节机能。结果：工期烟雾病的脑血流自动调节参数-恢复率及相位与对照相比即显著降低(恢复率22.70±4.93%/s VS.40.78±20.92%/s, p0.05:相位35.20±12.29°VS.60.01±18.96°,p0.05)°而增益及相关函数自Ⅱ期开始也出现显著变化(增益0.40±0.16VS.0.86±0.50,p0.05:相关函数0.64±0.11VS.0.42±0.16,p0.05)。恢复率(r=-0.478,p0.05)、增益(r=-0.507,p0.001)及相位(r=-0.619,p0.001)均同狭窄程度显著相关。结论：烟雾病早期患者脑血流自动调节机能即显著受损,且自动调节参数与烟雾病血管分期显著负相关,表明调节机能受损程度随疾病的进展而加剧。第三部分大脑中动脉狭窄脑血流自动调节及脑血管反应性研究背景：既往研究表明,颈内动脉狭窄后脑血流自动调节及脑血管反应性会受损,且受损患者未来罹患缺血性卒中的风险显著增加。而颅内动脉尤其是大脑中动脉(middle cerebral artery,MCA)粥样硬化性狭窄在中国人群高发,且是缺血性卒中的主要病因。然而,目前有关大脑中动脉狭窄后脑血流自动调节及脑血管反应性的研究非常少。目的：研究大脑中动脉狭窄患者脑血流自动调节机能及脑血管反应性是否受损,以及二者同狭窄程度之间的关系。方法：入组21例经磁共振血管成像诊断为MCA狭窄的患者及15例健康对照。应用传递函数的算法分析MCA血流速度及动脉血压的自然波动以分析脑血流自动调节机能。应用自呼吸的方法测量脑血管反应性。结果：MCA中度狭窄侧的脑血流自动调节参数(恢复率、相位)及脑血管反应性参数与对照相比均显著降低(恢复率17.76±8.21%/s VS.39.62±27.99%/s, pO.05:相位26.93±15.67. VS.55.66±22.10., p0.05:脑血管反应性1.53±0.84%/mmHg VS.2.18±0.80%/舳Hg, p0.05)..恢复率(r=-0.698,p0.001)、相位(r=-0.738,p0.001)及脑血管反应性(r=-0.690, p0.001)均同狭窄程度显著相关。结论：MCA狭窄超过50%的患者同侧脑血流自动调节及脑血管反应性受损,且受损程度随狭窄的程度增加而加剧。
[Abstract]:The prediction of future cerebral ischemic events in the first part of the moyamoya patients with the micro embolus signal
Research background:
Cerebral infarction in patients with moyamoya disease has been considered to be due to hypoperfusion caused by vascular stenosis. However, recent studies have shown that in patients with moyamoya disease to microembolic signal detection (microembolic signals MES). This shows that the micro embolism artery to artery occurred in moyamoya disease. However, the role of MES in cerebral infarction patients with moyamoya the disease is not clear.
Objective: To explore the role of MES in predicting the future cerebral ischemic events in patients with moyamoya disease.
Methods: 54 cases were consecutively recruited patients with moyamoya disease. Transcranial Doppler ultrasound (transcranial Doppler, TCD) in patients with bilateral cerebral artery monitoring group in 30 minutes. 1 years of follow-up, the primary end point event records: ischemic stroke and transient ischemic attack (transient ischemic, attack, TIA) of the situation.
Results: a total of 11 (20.4%) patients monitoring in patients with smoke to MES, accounting for the number of hemisphere moyamoya disease 10.2%.Logistic regression analysis showed that MES patients with moyamoya disease within 3 months of symptoms related to cerebral ischemia (OR=4.41,95%CI1.11-17.59). During a median follow-up of 384 days, a total of 14 (13%) cerebral hemispheres ischemic events (7 cases of ischemic stroke, 7 cases of TIA).Cox survival analysis showed that after adjusting for age, gender, history of ischemic stroke and TIA, and the SUZUKI stage after revascularization, the risk of MES positive hemisphere ischemic stroke occurred and the TIA is 6.84 times higher than the MES negative hemisphere (95%CI1.82-25.66), the risk of ischemic stroke is 10.61 times the negative hemisphere (95%CI1.66-67.70),
Conclusion: MES in patients with moyamoya disease is related to recent ischemic symptoms, and MES is an independent predictor of future ischemic events in moyamoya disease. Monitoring TCD micro emboli in moyamoya disease patients will help better clinical management for patients.
Study on the function of automatic regulation of cerebral blood flow in second part of moyamoya disease
Background: Previous studies have shown that cerebral blood flow autoregulation in patients with moyamoya disease is impaired, may increase the risk of bleeding and cerebral ischemia. However, gradually in moyamoya disease process, we do not know the automatic adjustment of cerebral protective mechanism of this important was damaged from when, and how with the progression of the disease and change.
Objective: To study the relationship between the dynamic cerebral blood flow regulation function and the vascular staging of moyamoya disease in patients with moyamoya disease with a new noninvasive method.
Methods: 13 cases enrolled by digital subtraction angiography in the diagnosis of bilateral moyamoya disease patients and 10 healthy controls. The modified SUZUKI staging classification of vascular group 26 moyamoya disease hemisphere. Application of transfer function algorithm for analysis of natural fluctuations in blood flow velocity and blood pressure in the brain to analyze cerebral blood flow the automatic adjustment function.
Results: the cerebral blood flow duration of moyamoya disease - recovery rate and automatically adjust the parameters with the control phase is significantly lower than that (the recovery rate of 22.70 + 4.93%/s VS.40.78 + 20.92%/s, p0.05: phase 35.20 + 12.29 ~ VS.60.01 - 18.96 degrees P0.05 degrees) and self correlation function gain and phase II began a significant change (a gain of 0.40 + 0.16VS.0.86 + 0.50, p0.05: function 0.64 + 0.11VS.0.42 + 0.16, P0.05). The recovery rate (r=-0.478, P0.05) (r=-0.507, p0.001), the gain and phase (r=-0.619, p0.001) were significantly correlated with the degree of stenosis.
Conclusion: the automatic regulation function of cerebral blood flow is significantly impaired in early stage of moyamoya disease, and the automatic regulation parameters are negatively correlated with the vascular staging of moyamoya disease, indicating that the degree of dysfunction of regulation is aggravated with the progression of disease.
The study of cerebral blood flow automatic regulation and cerebrovascular reactivity in the third part of middle cerebral artery stenosis
Background: Previous studies have shown that carotid artery stenosis of cerebral blood flow autoregulation and cerebrovascular reactivity will be damaged, and the damage significantly increased the risk of developing in patients with ischemic stroke. And intracranial artery especially middle cerebral artery (middle cerebral, artery, MCA) China atherosclerotic stenosis in high risk population, and is a major cause of ischemic stroke however, very few studies on middle cerebral artery stenosis cerebral blood flow autoregulation and cerebrovascular reactivity at present.
Objective: To study the function of cerebral blood flow automatic regulation and the damage of cerebrovascular reactivity in patients with middle cerebral artery stenosis, and the relationship between the two and the degree of stenosis.
Methods: 21 cases enrolled by magnetic resonance angiography in the diagnosis of MCA stenosis patients and 15 healthy controls. Natural fluctuations in application of transfer function algorithm analysis of MCA blood flow velocity and arterial blood pressure to analyze cerebral blood flow autoregulation function. Methods from respiratory measurement of cerebral vascular reactivity.
Results: the cerebral blood flow MCA moderate stenosis side of the automatic adjustment of parameters (recovery phase) and cerebral vascular reactivity parameters with the control decreased (the recovery rate of 17.76 + 8.21%/s VS.39.62 + 27.99%/s, pO.05: + 15.67. + 22.10. VS.55.66 26.93 phase p0.05:, cerebrovascular reactivity of 1.53 + 0.84%/mmHg VS.2.18 + 0.80%/ Hg boot. P0.05). The recovery rate (r=-0.698, p0.001), phase (r=-0.738, p0.001) and cerebral vascular reactivity (r=-0.690, p0.001) were significantly correlated with the degree of stenosis.
Conclusion: the ipsilateral cerebral blood flow automatic regulation and cerebrovascular reactivity are impaired in more than 50% of the patients with MCA stenosis, and the degree of damage increases with the increase of the degree of stenosis.

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R743.3

【相似文献】