Pánczél Gyula, Bönöczk Péter, Nagy Zoltán
Agyérbetegségek Országos Központja, 1021 Budapest, Húvösvölgyi út 116.
Ideggyogy Sz. 2002 Mar 20;55(3-4):95-101.
Cerebrovascular small vessel disease may lead to an impairment of vasoreactivity (VR). Vasoregulatory impairment in internal carotid artery distribution area has been established. In this study the authors sought the answer to the question if VR of vertebrobasilar (VB) territory was impaired in brainstem small vessel diseases and if vasoregulatory impairment differed between the two distribution territories.
VR of carotid and VB territory was compared applying different functional tests (ventilation, tilting, acetazolamide) in 25 patients with brainstem lacunar infarcts, 20 patients with periventricular leukoaraiosis and in 35 control subjects. Cerebral blood flow velocity (CBFV) of basilar artery (BA) and middle cerebral artery (MCA) was monitored with transcranial Doppler (TCD), systemic blood pressure and CO2 partial pressure of expired air were also registered.
In the BA territory the VR was significantly smaller in the patient than in the control group (3.1 +/- 4.6 cm/sec/kPa vs. 8.2 +/- 6.2 cm/sec/kPa, p = 0.01) during hypercapnia. In a subgroup of patients with mean baseline CBFV < 25 cm/sec, the VR was significantly smaller and Pl non-significantly higher than in patients with baseline CBFV > 25 cm/s (VRCO2 1.5 +/- 2.0 cm/sec/kPa vs. 6.5 +/- 6.5 cm/sec/kPa, p = 0.007; Pl 1.11 +/- 0.30 vs. 1.0 +/- 0.26, p = 0.4) indicating higher vascular resistance in the former group. Results of tilting tests showed similar but nonsignificant changes while acetazolamide tests revealed no differences between the two groups. In the MCA territory the VR was significantly lower in patients than in the controls during hypercapnia (4.7 +/- 3.7 cm/sec/kPa vs. 18.4 +/- 6.8 cm/sec/kPa, p < 0.001) and showed a nonsignificant tendency to be lower in patients than in controls during hypocapnia (14.6 +/- 13.8 cm/sec/kPa vs. 24.7 +/- 21.2 cm/sec/kPa, p = 0.1). Although CBFV measurements during acetazolamide test tended to support these findings, they showed no significant differences between patients and controls. During head-up tilt the CBFV did not differ significantly between the two groups. The VRCO2 is significantly higher in the MCA than in the BA territory (18.4 CI95 2.98 vs. 10.1 CI95 3.01; p < 0.001). The impairment of VRCO2 was more severe in the MCA territory (VR decreased to 26% of baseline in the MCA and to 34% in the BA territory).
The capacity of carotid territory VR exceeds that of VB territory. The impairment of VR is present in both the carotid and VB territories and is more severe in the former region. The most feasible test to reveal this impairment is the hypercapnic test. There is a strong correlation between the extent of vasoregulatory impairment and baseline CBFV in brainstem small vessel diseases.
脑血管小血管疾病可能导致血管反应性（VR）受损。颈内动脉分布区域的血管调节功能障碍已得到证实。在本研究中，作者试图回答以下问题：在脑干小血管疾病中，椎基底动脉（VB）区域的VR是否受损，以及两个分布区域之间的血管调节功能障碍是否存在差异。
对25例脑干腔隙性梗死患者、20例脑室周围白质疏松症患者和35例对照者应用不同的功能测试（通气、倾斜、乙酰唑胺）比较颈动脉和VB区域的VR。用经颅多普勒（TCD）监测基底动脉（BA）和大脑中动脉（MCA）的脑血流速度（CBFV），同时记录全身血压和呼出气体的二氧化碳分压。
在高碳酸血症期间，BA区域患者的VR明显低于对照组（3.1±4.6cm/sec/kPa对8.2±6.2cm/sec/kPa，p = 0.01）。在平均基线CBFV<25cm/sec的患者亚组中，VR明显较小，搏动指数（PI）略高于基线CBFV>25cm/s的患者（VRCO2 1.5±2.0cm/sec/kPa对6.5±6.5cm/sec/kPa，p = 0.007；PI 1.11±0.30对1.0±0.26，p = 0.4），表明前一组的血管阻力较高。倾斜试验结果显示出类似但不显著的变化，而乙酰唑胺试验显示两组之间无差异。在MCA区域，高碳酸血症期间患者的VR明显低于对照组（4.7±3.7cm/sec/kPa对18.4±6.8cm/sec/kPa，p<0.001），低碳酸血症期间患者的VR有略低于对照组的趋势（14.6±13.8cm/sec/kPa对24.7±21.2cm/sec/kPa，p = 0.1）。尽管乙酰唑胺试验期间的CBFV测量结果倾向于支持这些发现，但患者和对照组之间无显著差异。头高位倾斜期间，两组之间的CBFV无显著差异。MCA区域的VRCO2明显高于BA区域（18.4 CI95 2.98对10.1 CI95 3.01；p<0.001）。MCA区域VRCO2的损害更严重（MCA区域VR降至基线的26%，BA区域降至34%）。
颈动脉区域的VR能力超过VB区域。颈动脉和VB区域均存在VR损害，且在前一区域更严重。揭示这种损害最可行的测试是高碳酸血症试验。脑干小血管疾病中血管调节功能障碍的程度与基线CBFV之间存在很强的相关性。
