Kimura Yasuyuki, Oku Naohiko, Kajimoto Katsufumi, Katoh Hiroki, Tanaka Makiko Rai, Takasawa Masashi, Imaizumi Masao, Kitagawa Kazuo, Hori Masatsugu, Hatazawa Jun
Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, D9, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
Ann Nucl Med. 2006 Apr;20(3):209-15. doi: 10.1007/BF03027432.
Impaired cerebrovascular reactivity (CVR) to vasodilating agents is a predictor of the onset and prognosis of ischemic stroke. It is realized that the CVR improves or worsens when measured periodically during the clinical course in medically treated patients with occlusive cerebrovascular disease. In these patients, we investigated the possible relationship between the interval change in CVR and that in systemic blood pressure (BP).
Forty-two patients (14 females and 28 males, mean age +/- SD: 65.3 +/- 8.8 years) with severe stenosis or occlusion of the common carotid, internal carotid, or middle cerebral arteries repeatedly underwent single photon emission computed tomography (SPECT) studies using 123I-iodoamphetamine to measure cerebral blood flow (CBF) distribution and CVR at a more-than-6-month interval (mean +/- SD: 18.5 +/- 8.8 months). The CVR was separately estimated in cerebral hemispheres ipsilateral and contralateral to the most severe vascular lesion as the % increase in CBF after acetazolamide loading to CBF at rest. Systemic BP was measured four times at enrollment and the follow-up SPECT studies during resting and acetazolamide loading. Average BP at each SPECT study was an average of BP measurements during resting and acetazolamide loading. Interval changes in CVR were correlated with those in average systolic BP, average diastolic BP, and average mean arterial BP.
The interval changes in CVR were significantly correlated with those in average diastolic BP in the ipsilateral hemisphere (y = 0.71x + 1.43, r2 = 0.11, p < 0.05) and in the contralateral hemisphere (y = 0.88x - 0.46, r2 = 0.16, p < 0.05) but not with those in average systolic BP or average mean arterial BP.
In medically treated patients with steno-occlusive carotid artery or middle cerebral artery lesions, the interval change in CVR to acetazolamide by means of 123I-IMP SPECT was influenced by the diastolic BP at the SPECT studies. Monitoring diastolic BP is important to evaluate interval change in CVR.
脑血管对血管扩张剂的反应性受损是缺血性中风发病和预后的预测指标。现已认识到，在接受药物治疗的闭塞性脑血管疾病患者的临床病程中定期测量时，脑血管反应性会改善或恶化。在这些患者中，我们研究了脑血管反应性的间隔变化与系统性血压（BP）变化之间的可能关系。
42例（14例女性和28例男性，平均年龄±标准差：65.3±8.8岁）颈总动脉、颈内动脉或大脑中动脉严重狭窄或闭塞的患者，每隔6个月以上（平均±标准差：18.5±8.8个月）重复进行单光子发射计算机断层扫描（SPECT）研究，使用123I-碘安非他明测量脑血流（CBF）分布和脑血管反应性。脑血管反应性在最严重血管病变同侧和对侧的脑半球中分别估计，以乙酰唑胺负荷后CBF相对于静息时CBF的增加百分比来表示。在入组时以及静息和乙酰唑胺负荷期间的随访SPECT研究中测量4次系统性血压。每次SPECT研究时的平均血压是静息和乙酰唑胺负荷期间血压测量值的平均值。脑血管反应性的间隔变化与平均收缩压、平均舒张压和平均平均动脉压的变化相关。
同侧半球（y = 0.71x + 1.43，r2 = 0.11，p < 0.05）和对侧半球（y = 0.88x - 0.46，r2 = 0.16，p < 0.05）中，脑血管反应性的间隔变化与平均舒张压的变化显著相关，但与平均收缩压或平均平均动脉压的变化无关。
在接受药物治疗的伴有颈动脉或大脑中动脉狭窄闭塞性病变的患者中，通过123I-IMP SPECT测量的对乙酰唑胺的脑血管反应性间隔变化受SPECT研究时舒张压的影响。监测舒张压对于评估脑血管反应性的间隔变化很重要。
