多发性硬化症患者的脑血流动力学

Cerebral hemodynamics in patients with multiple sclerosis.

作者信息

Lattanzi Simona, Acciarri Maria Cristina, Danni Maura, Taffi Ruja, Cerqua Raffaella, Rocchi Chiara, Silvestrini Mauro

机构信息

Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020 Ancona, Italy.

出版信息

Mult Scler Relat Disord. 2020 Sep;44:102309. doi: 10.1016/j.msard.2020.102309. Epub 2020 Jun 17.

DOI:10.1016/j.msard.2020.102309

PMID:32619964

Abstract

BACKGROUND AND PURPOSE

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. Although the currently predominant view is that of an autoimmune inflammatory condition, changes in brain vasculature can occur and contribute to pathophysiology. The aim of this study was to evaluate cerebral hemodynamics in patients with MS and explore its relationship with disease status.

METHODS

Patients with MS and age- and sex- matched healthy controls were recruited. All participants underwent assessment of cerebral hemodynamics through transcranial Doppler ultrasonography. Cerebral vasomotor reactivity (CVR) to hypercapnia was measured by the breath-holding index (BHI).

RESULTS

A total of 80 patients with MS and 80 healthy controls were recruited. BHI values obtained in healthy controls, relapsing-remitting (RR)-MS and secondary progressive (SP)-MS patients were 1.15±0.11, 0.87±0.18 and 0.51±0.20, respectively (p<0.001). Group-wise, patients showed decreased CVR in comparison to controls and BHI values were significantly lower in SP-MS than in RR-MS patients. At linear regression analysis, the disease form was significantly associated with cerebral hemodynamics being the SP phenotype an independent predictor of lower BHI values [β=-0.36, 95% confidence interval (CI): -0.44 to -0.27, p<0.001; adjusted β=-0.37, 95% CI: -0.50 to -0.23, p<0.001).

CONCLUSIONS

Cerebrovascular hemodynamic insufficiency in MS may be secondary to the downstream effects of neuro-inflammatory cascades.

摘要

背景与目的

多发性硬化症（MS）是一种中枢神经系统脱髓鞘疾病。尽管目前的主流观点认为它是一种自身免疫性炎症疾病，但脑脉管系统会发生变化并参与病理生理过程。本研究旨在评估MS患者的脑血流动力学，并探讨其与疾病状态的关系。

方法

招募了MS患者以及年龄和性别匹配的健康对照者。所有参与者均通过经颅多普勒超声评估脑血流动力学。通过屏气指数（BHI）测量对高碳酸血症的脑血管舒缩反应性（CVR）。

结果

共招募了80例MS患者和80名健康对照者。健康对照者、复发缓解型（RR）-MS患者和继发进展型（SP）-MS患者的BHI值分别为1.15±0.11、0.87±0.18和0.51±0.20（p<0.001）。按组分析，与对照相比，患者的CVR降低，且SP-MS患者的BHI值显著低于RR-MS患者。在线性回归分析中，疾病类型与脑血流动力学显著相关，SP表型是BHI值降低的独立预测因素[β=-0.36，95%置信区间（CI）：-0.44至-0.27，p<0.001；校正β=-0.37，95%CI：-0.50至-0.23，p<0.001]。