Lin Ching-Huang, Yen Cheng-Chung, Hsu Yi-Ting, Chen Hsin-Hung, Cheng Pei-Wen, Tseng Ching-Jiunn, Lo Yuk-Keung, Chan Julie Y H
Department of Biological Sciences, National Sun Yet-Sen University, Kaohsiung 80424, Taiwan.
Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
J Clin Med. 2019 Mar 3;8(3):300. doi: 10.3390/jcm8030300.
Autonomic dysfunctions including impaired baroreflex sensitivity (BRS) can develop after acute ischemic stroke (AIS) and may predispose patients to subsequent cardiovascular adverse events and serve as potential indicators of long-term mortality. This study aimed to determine the potential short-term prognostic significance of BRS after AIS. All patients admitted to Kaohsiung Veterans General Hospital within 72 h after onset of first-ever AIS between April 2008 and December 2012 were enrolled. Autonomic evaluation with continuous 10-minute monitoring of beat-to-beat hemodynamic and intracranial parameters was performed within 1 week after stroke by using the Task Force Monitor and transcranial Doppler. The 176 enrolled AIS patients were divided into high-BRS and low-BRS groups. All but two enrolled patients (who died within 3 months after stroke) attended scheduled follow-ups. The high-BRS group had significantly lower National Institutes of Health Stroke Scale (NIHSS) scores at 1 and 2 weeks after stroke and at discharge; lower modified Rankin scale (mRS) scores 1, 3, 6, and 12 months after stroke; and lower rates of complications and stroke recurrence compared to the low-BRS group. This study provides novel evidence of the utility of BRS to independently predict outcomes after AIS. Furthermore, modifying BRS may hold potential in future applications as a novel therapeutic strategy for acute stroke.
自主神经功能障碍,包括压力反射敏感性(BRS)受损,可在急性缺血性卒中(AIS)后发生,并可能使患者易患随后的心血管不良事件,且可作为长期死亡率的潜在指标。本研究旨在确定AIS后BRS的潜在短期预后意义。纳入2008年4月至2012年12月期间首次发生AIS发病后72小时内入住高雄荣民总医院的所有患者。在卒中后1周内,使用动态心电监测仪和经颅多普勒对逐搏血流动力学和颅内参数进行连续10分钟监测,以进行自主神经评估。将176例纳入研究的AIS患者分为高BRS组和低BRS组。除两名纳入研究的患者(在卒中后3个月内死亡)外,所有患者均参加了定期随访。与低BRS组相比,高BRS组在卒中后1周、2周及出院时的美国国立卫生研究院卒中量表(NIHSS)评分显著更低;在卒中后1、3、6和12个月时的改良Rankin量表(mRS)评分更低;并发症和卒中复发率也更低。本研究为BRS可独立预测AIS预后提供了新证据。此外,调节BRS在未来应用中可能具有作为急性卒中新型治疗策略的潜力。