Zamboni Paolo, Menegatti Erica, Bartolomei Ilaria, Galeotti Roberto, Malagoni Anna Maria, Tacconi Giovanna, Salvi Fabrizio
Vascular Diseases Center, University of Ferrara, Ferrara, Italy.
Curr Neurovasc Res. 2007 Nov;4(4):252-8. doi: 10.2174/156720207782446298.
In multiple sclerosis (MS) plaques are known to be venocentric; in addition, MS lesions and peripheral venous disorders share a number of key features. To date, however, despite the anatomical relationship between MS lesions and the venous system, no information on the intracranial venous haemodynamics of MS is available. Eighty-nine consecutive MS patients (58 relapsing-remitting, 31 secondary progressive) matched with 60 controls underwent transcranial color-coded duplex sonography (TCCS). We assessed, in supine as well as in sitting positions, the direction of flow at the activation of the thoracic pump in the deep middle cerebral veins (dMCVs), and in the transverse sinus (TS). In the dMCVs, we also measured peak systolic velocity (PSV), peak diastolic velocity (PDV), as well as the resistance index (RI). Reflux/bidirectional flow rate was significantly higher in the MS population determining also significant differences in PDV, characterized by negative values (16.2+/-1 cm/sec in controls vs. -1.3 +/-2.6 cm/sec in MS, respectively, p<0.0001). Consequently, RI was dramatically increased in the MS group, affecting impedance of cerebral venous drainage (0.48+/-0.04 in controls vs. 1.1 +/-0.08 in MS, respectively p<0.0001). Therefore, the detection of reflux directed toward the subcortical grey matter was significantly associated to highest disability scores (p < 0.0001). Our study of MS patients demonstrated significant haemodynamic alterations detected in veins anatomically related to plaque disposition. Our findings should contribute towards understanding the role of altered venous flow and tissue drainage in the MS inflammatory chain, as well as in the neurodegenerative process.
在多发性硬化症（MS）中，已知斑块是以静脉为中心的；此外，MS病变和外周静脉疾病有许多关键特征。然而，迄今为止，尽管MS病变与静脉系统存在解剖学关系，但尚无关于MS患者颅内静脉血流动力学的信息。89例连续的MS患者（58例复发缓解型，31例继发进展型）与60例对照者接受了经颅彩色编码双功能超声检查（TCCS）。我们在仰卧位和坐位时评估了胸泵激活时大脑中深静脉（dMCV）和横窦（TS）的血流方向。在dMCV中，我们还测量了收缩期峰值流速（PSV）、舒张期峰值流速（PDV）以及阻力指数（RI）。MS患者的反流/双向流速显著更高，这也导致了PDV的显著差异，其特征为负值（对照组分别为16.2±1cm/秒，MS组为-1.3±2.6cm/秒，p<0.0001）。因此，MS组的RI显著升高，影响了脑静脉引流的阻抗（对照组分别为0.48±0.04，MS组为1.1±0.08，p<0.0001）。因此，检测到朝向皮质下灰质的反流与最高残疾评分显著相关（p<0.0001）。我们对MS患者的研究表明，在与斑块分布解剖相关的静脉中检测到了显著的血流动力学改变。我们的研究结果应有助于理解静脉血流改变和组织引流在MS炎症链以及神经退行性过程中的作用。
