Wu I-Hui, Sheng Wen-Yung, Hu Han-Hwa, Chung Chih-Ping
Department of Neurology, Taipei Veterans General Hospital, Taiwan.
Acta Neurol Taiwan. 2011 Mar;20(1):15-21.
Studies have found significant associations between jugular venous reflux (JVR) and neurological disorders. However, there still lacks evidences that JVR could influence cerebral circulation. The aim of the present study is trying to provide evidences that the retrogradely-transmitted venous pressure of JVR could reach cerebral venous system and has an influence on cerebral blood flow (CBF).
We recruited 50 volunteers. Only 42 subjects' data (55.81 ± 19.96, 23 - 85 years; 9 women) were analyzed due to poor temporal windows in eight subjects. JVR was determined by color-coded Duplex sonography. Transcranial Doppler study was used to examine the CBF changes during Valsalva maneuver (VM) in each subject.
All JVRs were detected during VM. We divided subjects into people with right JVR (n=12), left JVR (n=13) and no JVR (n=21) and four had bilateral JVR. There was a more decrease in CBF during and immediately after VM in right-JVR group than no-JVR group, though the baseline characteristics and arterial blood pressure changes were similar. There were no demographic and hemodynamic differences between left-JVR group and no-JVR group.
We are the first to provide evidences that right JVR during VM could influence CBF. However, whether left JVR with or without right JVR may have similar effect on CBF deserves further study. The definite mechanism underlying this finding needs further studies.
研究发现颈静脉反流(JVR)与神经系统疾病之间存在显著关联。然而,仍缺乏证据表明JVR会影响脑循环。本研究的目的是试图提供证据,证明JVR逆行传递的静脉压可到达脑静脉系统并对脑血流量(CBF)产生影响。
我们招募了50名志愿者。由于8名受试者的颞窗不佳,仅分析了42名受试者的数据(55.81±19.96,23 - 85岁;9名女性)。通过彩色编码双功超声检查确定JVR。采用经颅多普勒研究检测每位受试者在瓦尔萨尔瓦动作(VM)期间的CBF变化。
所有JVR均在VM期间检测到。我们将受试者分为右侧JVR者(n = 12)、左侧JVR者(n = 13)和无JVR者(n = 21),4人有双侧JVR。尽管基线特征和动脉血压变化相似,但右侧JVR组在VM期间及之后立即的CBF下降幅度比无JVR组更大。左侧JVR组和无JVR组在人口统计学和血流动力学方面无差异。
我们首次提供证据表明VM期间的右侧JVR会影响CBF。然而,左侧JVR无论有无右侧JVR是否对CBF有类似影响值得进一步研究。这一发现背后的确切机制需要进一步研究。