Bian Ying, Wang Jin-Chun, Sun Feng, Sun Zi-Yi, Lin Yu-Jiao, Liu Yang, Zhao Bin, Liu Li, Luo Xiao-Guang
Department of Neurology, the First Affiliated Hospital of China Medical University; Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China.
Department of Neurology, the Fifth People's Hospital of Shenyang, Shenyang, Liaoning Province, China.
Neural Regen Res. 2019 Aug;14(8):1412-1418. doi: 10.4103/1673-5374.251332.
Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43-93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth People's Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).
许多研究表明，脑白质疏松症与脑血管储备功能受损有关。然而，脑白质疏松症中发生的明确血流动力学变化尚不清楚，且存在诸多争议。本研究旨在利用经颅多普勒超声和屏气试验，对中国北方汉族人群中有症状的脑白质疏松症患者的血流动力学变化进行调查。本研究共纳入203例诊断为缺血性卒中或临床慢性进行性缺血症状的患者，其中男性97例，女性106例，年龄范围为43 - 93岁。根据Fazekas分级量表评估脑白质疏松症的严重程度，并据此将患者分为四组。0级为无脑白质疏松症，I级、II级和III级分别为轻度、中度和重度脑白质疏松症，每组分别有44例、79例、44例和36例。进行经颅多普勒超声检查和屏气试验。测量双侧大脑中动脉的平均血流速度并计算屏气指数。屏气指数与脑白质疏松症严重程度及认知障碍相关。屏气指数低的患者在蒙特利尔认知评估（MoCA）和执行功能测试中表现较差。也就是说，屏气指数越低，MoCA得分越低，而连线试验A部分和B部分得分越高。这些结果表明，屏气指数是评估脑白质疏松症患者脑血管储备功能损害的有用参数。此外，屏气指数可反映认知功能障碍，为脑白质疏松症的病理生理学提供了新的见解。本研究经中国沈阳第五人民医院伦理委员会批准（批准号：20160301），并在中国临床试验注册中心注册（注册号：ChiCTR1800014421）。
