| Background and objective:Dynamic cerebral autoregulation(dCA)is a mechanism of brain to make sure cerebral blood flow maintain relatively stable when the blood pressure fluctuated rapidly in certain range.dCA of patient who suffered from acute cerebral infarction(ACI)will be impaired,and the clinical outcome and prognosis of the patient is also closely related to the function of dCA.The aim of this study was to investigate the related risk factors associated with impaired dCA in patients with acute cerebral infarction,and to look for therapeutic targets that may improve the dCA.Methods:A total of 112 patients with unilateral anterior circulation cerebral infarction from the First Hospital of Jilin University were enrolled in this study.Fifty patients with age and sex matched were also included as the study control group.The middle cerebral artery(MCA)blood flow velocity was continuously monitored by transcranial Doppler ultrasonography.Simultaneous monitoring of arterial pressure was achieved by simultaneous monitoring of noninvasive fingertip blood pressure.The acquired data of arterial blood pressure and cerebral blood flow velocity were analyzed by transfer function analysis(TFA)to obtain the parameter of dCA: phase difference(PD)and gain.The linear regression analysis was performed on the PD values of bilateral cerebral hemispheres and the clinical factors to be explored Results:1.The mean age of patients was 52.18 ± 11.41 years(ranging from 27 to 77years),15(13.4%)patients were women.57(50.9%)patients with hypertension,18(16.1 %)patients with diabetes mellitus,39(34.8)patients with stroke history,73(65.2%)patients with smoking history,59(52.7%)patients with NIHSS score ≤3,69(61.61%)patients with ipsilateral cerebral arterial stenosis,21(18.75%)patients with mild stenosis in contralateral middle cerebral artery.2.The PD of ipsilateral hemisphere(38.14 ± 18.97°)was significantly lower than that in the contralateral hemisphere(43.13 ± 15.78°)and the PD of healthy control group(57.17±13.45°)(p>0.05),and PD of contralateral hemisphere was significantly lower than that in the healthy control group(p<0.001).3.The middle cerebral artery stenosis in the ipsilateral hemisphere has no interaction with low density lipoprotein cholesterol(p>0.05)4.Linear regression analysis showed that increasing of low density lipoprotein cholesterol is the risk factor of impaired dCA of bilateral hemisphere(ipsilateral: p =0.04;contralateral: p = 0.012),and ipsilateral middle cerebral artery stenosis(p<0.001)is the risk factor of impaired dCA of ipsilateral hemisphere.5.In different groups of stenosis degree of ipsilateral middle cerebral artery,the ipsilateral PD in the severe stenosis or occlusion group(29.20±16.50°)was significantly lower than that in the mild stenosis group(46.53±16.94° & 39.91±22.44)(p<0.001 & p=0.039),but there was no significant difference compared with the moderate stenosis group(35.11±17.21°)(p>0.05).Conclusions:1.dCA of the bilateral hemispheres of patients with ACI will be damaged,regardless of whether there is intracranial cerebrovascular stenosis.2 Ipsilateral middle cerebral artery stenosis is a related risk factor of impaired dCA in the ipsilateral hemisphere,and when it is severe stenosis or occlusion,the dCA would be damaged more serious.3.The increasing of low density lipoprotein cholesterol is a related risk factor of impaired dCA of bilateral hemisphere... |
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