Barnes Jill N, Harvey Ronée E, Miller Kathleen B, Jayachandran Muthuvel, Malterer Katherine R, Lahr Brian D, Bailey Kent R, Joyner Michael J, Miller Virginia M
From the Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison (J.N.B., K.B.M.); and Department of Anesthesiology (J.N.B., K.R.M., M.J.J.), College of Medicine and Science (R.E.H.), Department of Physiology and Biomedical Engineering (M.J., V.M.M.), Heath Science Research, Division of Epidemiology and Biostatistics (B.D.L., K.R.B.), and Department of Surgery (V.M.M.), Mayo Clinic, Rochester, MN.
Hypertension. 2018 Jan;71(1):110-117. doi: 10.1161/HYPERTENSIONAHA.117.10248. Epub 2017 Nov 20.
Cerebrovascular reactivity (CVR) is reduced in patients with cognitive decline. Women with a history of preeclampsia are at increased risk for cognitive decline. This study examined an association between pregnancy history and CVR using a subgroup of 40 age- and parity-matched pairs of women having histories of preeclampsia (n=27) or normotensive pregnancy (n=29) and the association of activated blood elements with CVR. Middle cerebral artery velocity was measured by Doppler ultrasound before and during hypercapnia to assess CVR. Thirty-eight parameters of blood cellular elements, microvesicles, and cell-cell interactions measured in venous blood were assessed for association with CVR using principal component analysis. Middle cerebral artery velocity was lower in the preeclampsia compared with the normotensive group at baseline (63±4 versus 73±3 cm/s; =0.047) and during hypercapnia (=0.013-0.056). CVR was significantly lower in the preeclampsia compared with the normotensive group (2.1±1.3 versus 2.9±1.1 cm·s·mm Hg; =0.009). Globally, the association of the 7 identified principal components with preeclampsia (=0.107) and with baseline middle cerebral artery velocity (=0.067) did not reach statistical significance. The interaction between pregnancy history and principal components with respect to CVR (=0.084) was driven by a nominally significant interaction between preeclampsia and the individual principal component defined by blood elements, platelet aggregation, and interactions of platelets with monocytes and granulocytes (=0.008). These results suggest that having a history of preeclampsia negatively affects the cerebral circulation years beyond the pregnancy and that this effect was associated with activated blood elements.
认知功能下降的患者脑血管反应性（CVR）降低。有先兆子痫病史的女性认知功能下降风险增加。本研究使用40对年龄和产次匹配的女性亚组，其中27名有先兆子痫病史，29名有血压正常的妊娠史，研究妊娠史与CVR之间的关联以及活化血液成分与CVR的关联。通过在高碳酸血症前后用多普勒超声测量大脑中动脉速度来评估CVR。使用主成分分析评估静脉血中测量的38项血细胞成分、微泡和细胞间相互作用参数与CVR的关联。在基线时（63±4对73±3cm/s；P=0.047）和高碳酸血症期间（P=0.013 - 0.056），先兆子痫组的大脑中动脉速度低于血压正常组。与血压正常组相比，先兆子痫组的CVR显著降低（2.1±1.3对2.9±1.1cm·s·mmHg；P=0.009）。总体而言，所确定的7个主成分与先兆子痫（P=0.107）和基线大脑中动脉速度（P=0.067）之间的关联未达到统计学显著性。妊娠史与主成分在CVR方面的相互作用（P=0.084）是由先兆子痫与由血液成分、血小板聚集以及血小板与单核细胞和粒细胞相互作用所定义的单个主成分之间名义上显著的相互作用驱动的（P=0.008）。这些结果表明，有先兆子痫病史会对妊娠多年后的脑循环产生负面影响，并且这种影响与活化的血液成分有关。
