Kitamura Juri, Ueno Hiroki, Nagai Michiaki, Hosomi Naohisa, Honjo Kie, Nakamori Masahiro, Mukai Tomoya, Imamura Eiji, Nezu Tomohisa, Aoki Shiro, Ohshita Tomohiko, Nomura Eiichi, Wakabayashi Shinichi, Maruyama Hirofumi, Matsumoto Masayasu
Eur Neurol. 2018;79(1-2):90-99. doi: 10.1159/000486306. Epub 2018 Jan 15.
The aim of this study was to elucidate the influence of insular infarction on blood pressure (BP) variability and outcomes according to the region of the insular cortex affected.
A total of 90 patients diagnosed with acute unilateral ischemic stroke were registered. The BP variability was calculated over 24 h after admission (hyperacute) and for 2-3 days after admission (acute). Patients were classified into groups of right and left, and then right anterior, right posterior, left anterior, and left posterior insular infarction.
Patients with insular infarction showed a significantly larger infarct volume, higher modified Rankin scale scores, and lower SD and coefficient of variation (CV) of -systolic BP in the hyperacute phase than shown by patients without insular infarction (p < 0.01, p < 0.01, p = 0.02, and p = 0.03, respectively). The SD and CV of systolic BP in the hyperacute phase showed significant differences among the 3 groups with right insular infarction, with left insular infarction, and without insular infarction (p < 0.05 and p < 0.05, respectively). There was a tendency for the systolic BP variability to be lower in patients with right anterior insular infarction than in patients with infarcts in other areas.
The right insular cortex, especially the anterior part, might be a hub for autonomic nervous regulation.
本研究旨在根据岛叶皮质受影响的区域，阐明岛叶梗死对血压（BP）变异性及预后的影响。
共纳入90例诊断为急性单侧缺血性卒中的患者。入院后24小时（超急性期）及入院后2 - 3天（急性期）计算血压变异性。患者分为右侧和左侧组，然后再分为右侧前部、右侧后部、左侧前部和左侧后部岛叶梗死组。
与无岛叶梗死的患者相比，岛叶梗死患者在超急性期梗死体积显著更大、改良Rankin量表评分更高，收缩压的标准差（SD）和变异系数（CV）更低（分别为p < 0.01、p < 0.01、p = 0.02和p = 0.03）。超急性期收缩压的SD和CV在右侧岛叶梗死组、左侧岛叶梗死组和无岛叶梗死组之间存在显著差异（分别为p < 0.05和p < 0.05）。右侧前部岛叶梗死患者的收缩压变异性有低于其他梗死区域患者的趋势。
右侧岛叶皮质，尤其是前部，可能是自主神经调节的枢纽。
