Clinical Study Of Dynamic Cerebral Blood Flow Autoregulation In Patients With Leukoaraiosis

Objective: To investigate the changes of dynamic cerebral autoregulation(dynamic cerebral autoregulation,dCA)in patients with leukoaraiosis(Leukoaraiosis,LA)Methods: 1.60 patients with cranial MRI(magnetic resonance imaging,MRI)examinations and clinical diagnosis of leukoaraiosis were selected as the experimental group from May 2019 to October 2020 among outpatients and inpatients of the Department of Neurology III of the First Affiliated Hospital of Hebei North University.Based on the results of brain MRI examination and Fazekas scale,the degree of leukoaraiosis in the experimental group was evaluated.The patients in the LA group were divided into three groups: LA group 1.Group II and III(Fazekas I,II and III,respectively).2.34 patients without leukoaraiosis on outpatient and inpatient cranial MRI were selected as the control group,The general information of gender,age,hypertension,diabetes,smoking history and drinking history of the LA group and the control group were recorded and statistically analyzed,respectively.3.TCD was used to monitor and record bilateral middle cerebral artery blood flow velocity(CBFV),and finger non-invasive continuous sphygmomanometer to monitor and record mean arterial blood pressure(MAP)in the fingers,and the relevant parameters of dCA were analyzed by transfer function analysis: phase difference and gain.The data were statistically analyzed to evaluate the change of dCA.4.To further analyze the correlation between the degree of leukoaraiosis and the ability of dynamic cerebral autoregulation.Results: The bilateral phase difference in the experimental group decreased significantly,and there was a statistically significant difference compared with the control group(P<0.01),suggesting that the dynamic cerebral autoregulation ability of LA patients was significantly impaired;the phase difference between the left and right sides in the same group of the LA group decreased,and there was no significant difference in the decline level(P > 0.05);the level of decrease in phase difference between the left and right sides in the LA I and LA II groups was not statistically significant(P>0.05);while there was a statistically significant difference between these two groups and LA III group in the level of decrease in phase difference between the left and right sides(P<0.01).dCA showed a significant positive correlation with the degree of LA lesion(P<0.01);there was no statistically significant difference between the experimental groups and the control group in the bilateral gain(P>0.05);dCA had some predictive value for the degree of LA lesion.The cutoff value of phase is36.24,the sensitivity was 82.6% and the specificity was 73.0%.Conclusion: 1.Dynamic cerebral autoregulation in LA patients is significantly impaired compared with that in non-LA patients;2.Both left and right dCA were impaired within the same group in the experimental group and there was no difference in the degree of impairment,suggesting that cerebral white matter sparing is a whole brain diffuse lesion.3.There was a significant positive correlation between the degree of LA lesion and the change of dCA,that is,the more severe the LA lesion was,the more obvious the decrease of dCA level was.4.The degree of LA lesions can be predicted by monitoring dCA.