Chang Ya-Ting, Chang Wen-Neng, Tsai Nai-Wen, Huang Chih-Cheng, Wang Hung-Chen, Kung Chia-Te, Su Yu-Jih, Lin Wei-Che, Chang Hsueh-Wen, Cheng Ben-Chung, Su Chih-Min, Chiang Yi-Fang, Lu Cheng-Hsien
Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Neurol Sci. 2015;353(1-2):143-8. doi: 10.1016/j.jns.2015.04.035. Epub 2015 Apr 29.
Symptomatic internal carotid artery occlusion (ICAO) is an important cause of cerebral ischemia with poor long-term outcome. Reductions in baroreflex function is reported in carotid atherosclerosis and implicated in increased risk of recurrent cardiovascular events. A distributed network of forebrain regions can exert modulatory influences over the cardio-vagal and baroreflex functions. The successful clinical translation of these approaches offers insights into underlying modulatory mechanisms and to possible therapeutic strategy.
This study enrolled 20 symptomatic ICAO survivors, 20 patients with small vessel disease (SVD) as risk control, and 20 healthy controls. All underwent a standardized evaluation of cardiovascular autonomic function testing that included baroreflex sensitivity (BRS), Valsalva ratio (VR), and heart rate response to deep breathing (HR_DB). The regional cerebral blood flow (rCBF) of the central autonomic network (CAN) was obtained from arterial spin-labeling magnetic resonance imaging. Parameters of autonomic function between symptomatic ICAO survivors with and those without recurrent cardiovascular events were compared.
Valsalva ratio and HR_DB levels were significantly higher in the control group, followed by the SVD and ICAO groups (p=0.009 and p=0.007, respectively). Spontaneous BRS and BRS during the early phase II of Valsalva maneuver levels were both significantly higher in the control group, followed by the SVD and ICAO groups (p<0.001 and p=0.042, respectively). The rCBF of CAN inversely correlated with spontaneous BRS.
Autonomic dysregulation, including reduced BRS and impaired cardio-vagal function in the convalescent stage ICAO, can persist for a long time. Reduced BRS is inversely correlated with CAN activity.
有症状的颈内动脉闭塞（ICAO）是脑缺血的重要原因，长期预后较差。据报道，颈动脉粥样硬化患者的压力反射功能降低，且与复发性心血管事件风险增加有关。前脑区域的分布式网络可对心迷走神经和压力反射功能产生调节影响。这些方法的成功临床转化为潜在的调节机制和可能的治疗策略提供了见解。
本研究纳入了20名有症状的ICAO幸存者、20名患有小血管疾病（SVD）的患者作为风险对照以及20名健康对照者。所有人都接受了心血管自主神经功能测试的标准化评估，包括压力反射敏感性（BRS）、瓦尔萨尔瓦比率（VR）以及对深呼吸的心率反应（HR_DB）。通过动脉自旋标记磁共振成像获得中枢自主神经网络（CAN）的局部脑血流量（rCBF）。比较了有和没有复发性心血管事件的有症状ICAO幸存者之间的自主神经功能参数。
对照组的瓦尔萨尔瓦比率和HR_DB水平显著更高，其次是SVD组和ICAO组（分别为p = 0.009和p = 0.007）。对照组的自发BRS和瓦尔萨尔瓦动作II期早期的BRS水平均显著更高，其次是SVD组和ICAO组（分别为p < 0.001和p = 0.042）。CAN的rCBF与自发BRS呈负相关。
自主神经调节异常，包括在ICAO恢复期BRS降低和心迷走神经功能受损，可长期持续存在。BRS降低与CAN活动呈负相关。
