Department for Diagnostic and Therapeutical Procedures, Neurology Unit, General Hospital Našice, Bana Jelačića 10, 31500, Našice, Croatia.
Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Josipa Huttlera 4, 31000, Osijek, Croatia.
Acta Neurol Belg. 2019 Dec;119(4):567-575. doi: 10.1007/s13760-019-01170-y. Epub 2019 Jun 18.
Impaired cerebrovascular reactivity (CVR) is associated with stroke. Cerebrovascular diseases are common comorbidity in chronic obstructive pulmonary disease (COPD) patients. The aim of our study was to quantify CVR in the anterior and posterior cerebral circulation during voluntary breath-holding in COPD patients according to airflow limitation severity. In this cross-sectional study, we compared 90 COPD patients without previous cerebrovascular disease and 30 age- and sex-matched healthy volunteers (mean age 67 ± 7.9, 87 males). Using transcranial Doppler ultrasound and breath-holding index (BHI), we analysed baseline mean flow velocities (MFV) and CVR of middle cerebral artery (MCA) and basilar artery (BA). Our results demonstrated that COPD patients had lower baseline MFV of both MCA and BA than controls. COPD patients had significantly lower BHIMCA and BHIBA than controls (0.8 and 0.7 versus 1.24 and 1.07, respectively; p < 0.001). With the severity of airflow obstruction, there were significant declines of BHIMCA and BHIBA in mild (0.94 and 0.83), moderate (0.8 and 0.7) and severe to very severe COPD (0.7 and 0.6), respectively (p < 0.001). For all participants, we found a significant and positive correlation between forced expiratory volume in one second (FEV) and BHIMCA (Rho = 0.761, p < 0.001) and between FEV and BHIBA (Rho = 0.409, p < 0.001). COPD patients have impaired CVR in anterior and posterior cerebral circulation. Impairment of CVR increase with the airflow limitation severity. CVR is an appropriate marker to identify vulnerable COPD subjects at high risk to develop cerebrovascular disease. Prospective studies are needed for further evaluation.
脑血流反应性（CVR）受损与中风有关。脑血管疾病是慢性阻塞性肺疾病（COPD）患者的常见合并症。我们的研究目的是根据气流受限严重程度，量化 COPD 患者在自愿屏气期间前循环和后循环的 CVR。在这项横断面研究中，我们比较了 90 例无先前脑血管疾病的 COPD 患者和 30 例年龄和性别匹配的健康志愿者（平均年龄 67±7.9 岁，87 名男性）。使用经颅多普勒超声和屏气指数（BHI），我们分析了大脑中动脉（MCA）和基底动脉（BA）的基线平均血流速度（MFV）和 CVR。我们的结果表明，与对照组相比，COPD 患者的 MCA 和 BA 基线 MFV 均较低。与对照组相比，COPD 患者的 MCA 和 BA 的 BHI 明显较低（分别为 0.8 和 0.7 与 1.24 和 1.07；p<0.001）。随着气流阻塞的严重程度，轻度（0.94 和 0.83）、中度（0.8 和 0.7）和重度至极重度 COPD（0.7 和 0.6）患者的 BHI-MCA 和 BHI-BA 均明显下降（均 p<0.001）。对于所有参与者，我们发现一秒用力呼气量（FEV）与 BHI-MCA 之间存在显著正相关（Rho=0.761，p<0.001），FEV 与 BHI-BA 之间存在显著正相关（Rho=0.409，p<0.001）。COPD 患者的前循环和后循环 CVR 受损。CVR 随着气流受限严重程度的增加而降低。CVR 是识别易发生脑血管疾病的高危 COPD 患者的合适标志物。需要进一步评估前瞻性研究。
