Janzarik Wibke G, Gerber Ann-Kathrin, Markfeld-Erol Filiz, Sommerlade Linda, Allignol Arthur, Reinhard Matthias
Department of Neuropediatrics and Muscular Diseases, Center of Pediatrics and Adolescent Medicine, Medical Center, University of Freiburg, Germany; Department of Neurology, Medical Center, University of Freiburg, Germany.
Department of Neurology, Medical Center, University of Freiburg, Germany; Department of Dermatology, Venerology and Allergology, General Hospital Karlsruhe, Germany.
Pregnancy Hypertens. 2018 Jul;13:171-173. doi: 10.1016/j.preghy.2018.06.009. Epub 2018 Jun 12.
Preeclampsia is a pregnancy-related hypertensive disorder with strongly impaired cerebral autoregulation in the acute stage. A history of preeclampsia is an independent cardiovascular and cerebrovascular risk factor. It is unclear whether impaired cerebral autoregulation persists after preeclampsia and thus contributes to the known increased cerebrovascular morbidity.
Using transcranial Doppler, we compared cerebral hemodynamics and dynamic cerebral autoregulation of 25 women with a history of severe preeclampsia and 25 healthy mothers, on average 2-3 years postpartum. Mean arterial blood pressure (MAP) and cerebral blood flow velocities (CBFV) in the middle and posterior cerebral artery were recorded at rest, dynamic cerebral autoregulation was assessed via transfer function phase and gain between oscillations of CBFV and MAP during regular breathing at 0.1 Hz.
MAP and body mass index were higher in former preeclamptic women compared with healthy mothers (p-value <0.001 and 0.006, respectively). CBFV in the middle cerebral artery was slightly increased in former preeclamptic women compared with healthy mothers (p-value 0.004), intima-media thickness (IMT) of the common carotid artery was higher by trend (p-value 0.065). Dynamic cerebral autoregulation was not impaired in women with a history of preeclampsia, phase even tended to be higher than in healthy mothers.
Dynamic cerebral autoregulation is not persistently impaired in women after severe preeclampsia. Long-term cerebrovascular changes rather result from a higher incidence of cerebrovascular risk factors in women with a history of preeclampsia.
子痫前期是一种与妊娠相关的高血压疾病，在急性期脑自动调节功能严重受损。子痫前期病史是独立的心血管和脑血管危险因素。目前尚不清楚子痫前期后脑自动调节功能受损是否持续存在，进而导致已知的脑血管发病率增加。
我们使用经颅多普勒比较了25名有重度子痫前期病史的女性和25名健康母亲产后平均2 - 3年的脑血流动力学和动态脑自动调节功能。在静息状态下记录平均动脉压（MAP）以及大脑中动脉和大脑后动脉的脑血流速度（CBFV），通过传递函数相位以及在0.1Hz规律呼吸期间CBFV和MAP振荡之间的增益来评估动态脑自动调节功能。
与健康母亲相比，有子痫前期病史的女性MAP和体重指数更高（p值分别<0.001和0.006）。与健康母亲相比，有子痫前期病史的女性大脑中动脉的CBFV略有增加（p值0.004），颈总动脉内膜中层厚度（IMT）有升高趋势（p值0.065）。有子痫前期病史的女性动态脑自动调节功能未受损，相位甚至往往高于健康母亲。
重度子痫前期后女性的动态脑自动调节功能不会持续受损。子痫前期病史女性脑血管长期变化更可能是由于脑血管危险因素发生率较高所致。
