Matsushita K, Kuriyama Y, Nagatsuka K, Nakamura M, Sawada T, Omae T
First Department of Internal Medicine, Osaka University Medical School, Japan.
Hypertension. 1994 May;23(5):565-8. doi: 10.1161/01.hyp.23.5.565.
The goal of this study was to elucidate the association between the development of periventricular white matter lucency and autoregulation of cerebral blood flow in hypertensive patients through the arteriovenous oxygen saturation difference method. We studied 51 hypertensive patients who had previously suffered from minor strokes (lacunar infarction, 43; deep basal minor hemorrhage, 8). Patients were divided into three groups based on the findings of periventricular white matter lucency. We measured the absolute value of resting cerebral blood flow using the argon inhalation method, and stepwise reduction of blood pressure was obtained with patients on a tilting table. Intracerebral venous blood sampling was accomplished by direct cannulation into the jugular vein up to the jugular bulb. We calculated several cerebral circulatory parameters, such as cerebrovascular resistance and cerebral oxygen consumption, and also delineated individual autoregulation curves. Cerebrovascular resistance was significantly greater in patients with severe periventricular white matter lucency than in patients without it (P < .05). Impaired autoregulation was also significantly more prevalent in patients with more severe periventricular lesions (P < .05). Multiple regression analysis revealed that the impaired autoregulation was significant and an independent determinant of the severity of such periventricular lesions (R = .34, P < .05). In conclusion, our findings indicated that hypertensive patients with severe periventricular white matter lucency were more likely to have impaired autoregulation of cerebral blood flow and suggest that stricter blood pressure control is required in such patients to prevent deterioration of the cerebral microcirculation.
本研究的目的是通过动静脉血氧饱和度差法阐明高血压患者脑室周围白质疏松症的发展与脑血流自动调节之间的关联。我们研究了51例既往有轻度卒中（腔隙性梗死43例；深部基底节区轻度出血8例）的高血压患者。根据脑室周围白质疏松症的检查结果将患者分为三组。我们采用氩气吸入法测量静息脑血流量的绝对值，并让患者躺在倾斜台上逐步降低血压。通过直接将导管插入颈静脉直至颈静脉球部来采集脑静脉血样。我们计算了几个脑循环参数，如脑血管阻力和脑氧消耗量，还描绘了个体自动调节曲线。重度脑室周围白质疏松症患者的脑血管阻力显著高于无此症状的患者（P < 0.05）。在脑室周围病变更严重的患者中，自动调节功能受损也明显更为普遍（P < 0.05）。多元回归分析显示，自动调节功能受损显著，并且是此类脑室周围病变严重程度的独立决定因素（R = 0.34，P < 0.05）。总之，我们的研究结果表明，重度脑室周围白质疏松症的高血压患者更有可能存在脑血流自动调节功能受损，并提示对此类患者需要更严格地控制血压，以防止脑微循环恶化。
