脑静脉窦血栓形成患者动态脑血流自动调节受损：基于TCD和默读刺激的评估

doi:10.3969/j.issn.1673-5765.2025.03.014

摘要/Abstract

摘要： 目的脑静脉窦血栓形成（cerebral venous sinus thrombosis，CVST）可能会损害大脑中动脉（middle cerebral artery，MCA）的动态脑血流自动调节（dynamic cerebral autoregulation，dCA）功能。本研究探讨CVST对MCA的dCA和默读期间大脑后动脉（posterior cerebral artery，PCA）的dCA及神经血管耦联（neurovascular coupling，NVC）的影响。
方法本研究在2021年1月—2022年8月，共纳入60例CVST患者（CVST组）和30例健康对照者（对照组）。使用TCD检测无创连续逐波血压、脑血流速度以及MCA和默读期间PCA的其他相关指标数据。根据MRI分期将CVST分为慢性期和非慢性期；根据CVST在MRI上的分布情况将CVST患者分为大范围组和小范围组。受试者根据语音提示睁、闭眼进行NVC评估，通过默读中国旅游材料实现睁眼视觉刺激。睁眼默读时，视觉刺激信号可以选择性地激活枕叶的布罗德曼区17、18和19，促使其释放神经递质并扩张PCA。通过传递函数分析确定dCA参数。
结果在默读期间PCA的dCA中，CVST组的超低频相位差低于对照组[52.91（29.56～75.12）°vs. 66.43（48.68～79.55）°，P=0.047]。在NVC中，CVST组的脑血管电导指数（index of the cerebrovascular conductance，CVCi）差值（∆CVCi）[0.09（0.08～0.12）cm·s－1·mmHg－1 vs. 0.12（0.09～0.15）cm·s－1·mmHg－1，P=0.017]（1 mmHg＝0.133 kPa）和视觉诱发血流反应（visually evoked flow response，VEFR）[25.36（18.28～32.43）% vs. 30.73（23.67～38.18）%，P=0.019]低于对照组。慢性期CVST患者与非慢性期CVST患者PCA的超低频相位差、∆CVCi和VEFR差异均无统计学意义。在CVST的分布范围方面，大范围组的VEFR低于小范围组，差异有统计学意义（P=0.018）。
结论与健康对照者相比，CVST患者默读时PCA的dCA和NVC受损。此外，NVC反应性与CVST累及范围相关，累及范围较大的患者对视觉刺激的NVC反应性低于累及范围较小的患者。

关键词: 脑静脉窦血栓形成; 经颅多普勒超声; 神经血管耦联; 默读; 动态脑血流自动调节; 传递函数分析

Abstract: Objective Cerebral venous sinus thrombosis (CVST) may impair dynamic cerebral autoregulation (dCA) of the middle cerebral artery (MCA). This study explored the effects of CVST on dCA of the MCA and the posterior cerebral artery (PCA) during silent reading and neurovascular coupling (NVC).
Methods From January 2021 to August 2022, 60 CVST patients (the CVST group) and 30 healthy controls (the control group) were enrolled in this study. Non-invasive continuous beat-to-beat blood pressure, cerebral blood flow velocity, and other associated information of the MCA and PCA during silent reading were collected using TCD. Based on the MRI staging, CVST was divided into chronic phase and non-chronic phase. Based on the distribution of CVST on MRI, CVST patients were divided into the large range group and the small range group. The subjects were assessed for NVC by opening and closing the eyes in response to voice prompts, with eye-open visual stimulation achieved by silent reading of Chinese tourism materials. When silent reading with eyes open, the visual stimulation signals can selectively activate Brodmann areas 17, 18, and 19 in the occipital lobe, prompting them to release neurotransmitters and dilate the PCA. The dCA parameters were determined by transfer function analysis.
Results In dCA of the PCA during silent reading, the CVST group’s very low frequency phase difference was lower than that of the control group [52.91 (29.56-75.12)° vs. 66.43 (48.68-79.55)°, P=0.047]. In NVC, the index of the cerebrovascular conductance (CVCi) changes (ΔCVCi) [0.09 (0.08-0.12) cm·s-1·mmHg-1 vs. 0.12 (0.09-0.15) cm·s-1·mmHg-1, P=0.017] (1 mmHg=0.133 kPa) and visually evoked flow response (VEFR) [25.36 (18.28-32.43) % vs. 30.73 (23.67-38.18) % , P=0.019] in the CVST group were lower than those in the control group. There were no statistically significant differences in the very low frequency phase difference, ΔCVCi, and VEFR of the PCA between patients with chronic CVST and non-chronic CVST. For the distribution range of CVST, the VEFR in the large range group was lower than that in the small range group, and the difference was statistically significant (P=0.018).
Conclusions Compared with healthy controls, the dCA and NVC of the PCA during silent reading were impaired in CVST patients. In addition, NVC reactivity was related to the involvement range of CVST. Patients with larger involvement range had lower NVC reactivity to visual stimulation than those with smaller involvement range.

Key words: Cerebral venous sinus thrombosis; Transcranial Doppler; Neurovascular coupling; Silent reading; Dynamic cerebral autoregulation; Transfer function analysis

中图分类号:

R74
R445.1

陈松伟, 陈虹秀, 段建钢, 崔柳平, 刘然, 邢英琦. 脑静脉窦血栓形成患者动态脑血流自动调节受损：基于TCD和默读刺激的评估[J]. 中国卒中杂志, 2025, 20(3): 357-364.

CHEN Songwei, CHEN Hongxiu, DUAN Jiangang, CUI Liuping, LIU Ran, XING Yingqi. Impaired Dynamic Cerebral Autoregulation in Patients with Cerebral Venous Sinus Thrombosis: Evaluation Using Transcranial Doppler and Silent Reading Stimulation[J]. Chinese Journal of Stroke, 2025, 20(3): 357-364.

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