上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2022, Vol. 42 ›› Issue (2): 178-184.doi: 10.3969/j.issn.1674-8115.2022.02.007

• 论著 · 临床研究 • 上一篇    

不同血压变异的肢体抖动短暂性脑缺血发作患者脑灌注特征

余爱勇1(), 赵迎春1, 潘晓春1, 周克贵1, 赵玉武2, 顾磊3()   

  1. 1.上海市松江区中心医院神经内科，上海 201699
    2.上海交通大学医学院附属第六人民医院神经内科，上海 200233
    3.上海市松江区中心医院放射科，上海 201699
  • 收稿日期:2021-09-26 出版日期:2022-02-28 发布日期:2022-03-17
  • 通讯作者: 顾磊 E-mail:aiyong07@sohu.com;1037215691@qq.com
  • 作者简介:余爱勇（1980—），男，副主任医师，硕士；电子信箱：aiyong07@sohu.com。
  • 基金资助:
    上海市松江区科学技术攻关项目(15SJGG30)

Characteristics of cerebral perfusion in patients with limb shaking-transient ischemic attacks with different blood pressure variations

Aiyong YU1(), Yingchun ZHAO1, Xiaochun PAN1, Kegui ZHOU1, Yuwu ZHAO2, Lei GU3()   

  1. 1.Department of Neurology, Shanghai Songjiang District Central Hospital, Shanghai 201699, China
    2.Department of Neurology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
    3.Department of Radiology, Shanghai Songjiang District Central Hospital, Shanghai 201699, China
  • Received:2021-09-26 Online:2022-02-28 Published:2022-03-17
  • Contact: Lei GU E-mail:aiyong07@sohu.com;1037215691@qq.com
  • Supported by:
    Science and Technology Research Project of Shanghai Songjiang District(15SJGG30)

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摘要：

目的·探索肢体抖动短暂性脑缺血发作（limb shaking-transient ischemic attack，LS-TIA）患者的血压波动与脑灌注和侧支循环变化的关系，为明确LS-TIA的发病机制提供依据。方法·采用回顾性队列研究，选取2018年1月—2019年12月，在上海市松江区中心医院神经内科住院的LS-TIA患者。以动态血压仪采集的收缩压标准差作为短时收缩压变异（short-term systolic blood pressure variation，SSBPV）指标，根据SSBPV水平，将LS-TIA患者分为SSBPV高组16例，SSBPV正常组14例，同期因头痛、头晕就诊的人群作为健康对照（healthy control，HC）组15例。收集患者年龄、性别、吸烟史、饮酒史、体质量指数、高血压病史、冠心病病史、高脂血症病史以及脑梗死病史资料。所有患者以1%利多卡因浸润麻醉，单弯导管行双侧颈总动脉、双侧颈内动脉、双侧锁骨下动脉、双侧椎动脉造影，由手术医师判断颅内动脉狭窄数目以及评估侧支循环开放情况。通过单光子发射计算机断层成像术（single-photon emission computed tomography，SPECT）检查，勾画感兴趣区（region of interest，ROI）；以小脑作对照，比值小于0.9，作为判断脑叶低灌注的标准。采用SPSS 25.0软件进行统计学分析，符合正态分布的定量资料2组间比较采用独立样本t检验，3组间比较采用方差分析。其余资料为定性资料，组间比较采用χ2检验，P<0.05为差异有统计学意义。结果·与HC组相比，SSBPV高组、SSBPV正常组的颅内动脉狭窄总数、颈内动脉狭窄数目增多，差异有统计学意义（均P=0.000）。SSBPV高组、SSBPV正常组出现低灌注的脑叶数高于HC组（均P=0.000），SSBPV高组出现严重低灌注的病例数高于HC组（P=0.000），SSBPV高组侧支循环开放的总数（P=0.001）、二级侧支循环开放数高于HC组（P=0.014）。与SSBPV正常组比较，SSBPV高组出现低灌注的脑叶数多（P=0.041），出现严重低灌注的病例数多（P=0.024），侧支循环开放的总数多（P=0.034）。结论·短时收缩压变异性增大，导致了LS-TIA患者脑低灌注范围更大，重度脑低灌注比例更高，这可能参与了LS-TIA的发病机制；而作为代偿机制之一，患者的侧支循环开放比例高。

关键词: 肢体抖动短暂性脑缺血发作, 脑血管造影, 血压变异, 脑灌注, 侧支循环

Abstract:

Objective·To investigate whether blood pressure fluctuations in patients with limb shaking-transient ischemic attacks (LS-TIA) are related to the changes of cerebral perfusion and collateral circulation, and explore the pathogenesis primarily.

Methods·This study was a retrospective cohort study. The patients with LS-TIA who were hospitalized in the Department of Neurology, Shanghai Songjiang District Central Hospital from January 2018 to December 2019 were selected. By using the standard deviation of systolic blood pressure collected by ambulatory sphygmomanometer as the short-term systolic blood pressure variation (SSBPV) index, the LS-TIA patients were divided into 16 cases in high SSBPV group and 14 cases in normal SSBPV group, according to the level of SSBPV. During the same period, 15 patients who went to hospital because of headache or dizziness served as healthy control (HC) group. The patients' age, gender, smoking history, drinking history, body mass index, history of hypertension, history of coronary heart disease, history of hyperlipidemia and history of cerebral infarction were collected. All the patients were anesthetized with 1% lidocaine, and underwent cerebral angiography with a single curved catheter, including bilateral common carotid arteries, bilateral internal carotid arteries, bilateral subclavian arteries, and bilateral vertebral arteries. The number of intracranial arterial stenosis and the patency of collateral circulation were assessed by the surgeon. By single-photon emission computed tomography (SPECT) examination, the region of interest (ROI) was delineated, and the cerebellum was used as a control. The ratio less than 0.9 was used as the criterion for judging lobe hypoperfusion. SPSS 25.0 software was used for statistical analysis. The measurement data conforming to the normal distribution were compared by independent samples t test between the two groups, and the comparison among the three groups was performed by variance analysis. The rest data were qualitative data, the chi-square test was used for comparison between the groups, and P<0.05 was considered statistically significant.

Results·Compared with the HC group, the total number of intracranial artery stenosis and the number of internal carotid artery stenosis in the high SSBPV group and the normal SSBPV group increased, and the differences were statistically significant (all P=0.000). The number of lobes with hypoperfusion in the high SSBPV group and the normal SSBPV group were higher than that in the HC group (all P=0.000). The number of cases with severe hypoperfusion in the high SSBPV group was higher than that in the HC group (P=0.000). The total number of open collateral circulation in the high SSBPV group was higher than that in the HC group (P=0.001), and the number of secondary collateral circulation in the high SSBPV group was higher than that in the HC group (P=0.014). Compared with the normal SSBPV group, the high SSBPV group had more lobes with hypoperfusion (P=0.041), more severe hypoperfusion cases (P=0.024), and more collateral circulation openings (P=0.034).

Conclusion·The increased short-term systolic blood pressure variability results in a wider range of cerebral hypoperfusion and a higher proportion of severe cerebral hypoperfusion in the patients with LS-TIA. This may contribute to the pathogenesis of LS-TIA. As a part of the compensatory mechanism, the proportion of openning collateral circulation in the patients is high.

Key words: limb-shaking transient ischemic attack (LS-TIA), cerebral angiography, blood pressure variability (BPV), cerebral perfusion, collateral circulation

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