急性缺血性卒中时肱动脉血流介导的血管舒张功能
Brachial arterial flow mediated dilation in acute ischemic stroke.
作者信息
Santos-García D, Blanco M, Serena J, Arias S, Millán M, Rodríguez-Yáñez M, Leira R, Dávalos A, Castillo J
机构信息
Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain.
出版信息
Eur J Neurol. 2009 Jun;16(6):684-90. doi: 10.1111/j.1468-1331.2009.02564.x. Epub 2009 Feb 19.
BACKGROUND AND PURPOSE
Brachial arterial flow-mediated dilation (FMD) reflects endothelium-dependent vasodilation function. FMD is diminished in patients with endothelial dysfunction (ED). Our aim was to investigate the relationship between FMD and outcome for patients with acute ischemic stroke.
METHODS
We measured FMD in 120 consecutive patients (58.3% male, median age 73 years) with acute ischemic stroke within the first 48 h of onset of the stroke, using high-resolution ultrasonography. FMD was calculated as the relationship between basal diameter of the brachial artery before (d(1)) and after (d(2)) transient vascular occlusion (300 mmHg for 4 min) was measured using a sphygmomanometer (FMD = d(2) - d(1)/d(1) x 100). Poor outcome was defined as modified Rankin Scale at 3 months >2. FMD was categorized according to ROC analysis and we defined ED as FMD < or = 4.5%.
RESULTS
Thirty-three patients (27.5%) had ED. Median % FMD was 9.12 (7.48). FMD negatively correlated to stroke severity (P = 0.045). Median FMD was significantly lower [4.5 (2.3, 10.3) vs. 9.4 (5.6, 15.1), P = 0.003] for patients with poor outcome (n = 38). The adjusted odds ratio of poor outcome for FMD < or = 4.5% was 3.03 (95% CI, 1.09-27.3).
CONCLUSIONS
Impaired FMD in patients with acute ischemic stroke is associated with poor outcome.
背景与目的
肱动脉血流介导的血管舒张（FMD）反映内皮依赖性血管舒张功能。内皮功能障碍（ED）患者的FMD降低。我们的目的是研究急性缺血性脑卒中患者FMD与预后之间的关系。
方法
我们使用高分辨率超声对120例连续的急性缺血性脑卒中患者（男性占58.3%，中位年龄73岁）在卒中发作后的头48小时内测量FMD。FMD通过使用血压计测量肱动脉在短暂血管闭塞前（d(1)）和后（d(2)）（300 mmHg持续4分钟）的基础直径之间的关系来计算（FMD = (d(2) - d(1)) / d(1) × 100）。预后不良定义为3个月时改良Rankin量表评分>2。根据ROC分析对FMD进行分类，我们将ED定义为FMD≤4.5%。
结果
33例患者（27.5%）存在ED。FMD的中位数百分比为9.12（7.48）。FMD与卒中严重程度呈负相关（P = 0.045）。预后不良的患者（n = 38）的FMD中位数显著更低[4.5（2.3，10.3）对9.4（5.6，15.1），P = 0.003]。FMD≤4.5%的患者预后不良的校正比值比为3.03（95%CI，1.09 - 27.3）。
结论
急性缺血性脑卒中患者FMD受损与预后不良相关。
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