Abstract:

Objective The relationship between right-to-left shunts (RLS) and migraine and cryptogenic stroke is not well understood. In this study, we investigated whether RLS are associated with impairment of dynamic cerebral autoregulation (dCA), which may play a role in migraine and cryptogenic stroke. Methods Sixty-six migraineurs were enrolled in the study, including 36 non-RLS patients and 30 RLS patients. Non-invasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously from each patient by using transcranial Doppler and servo-controlled plethysmograph, respectively. Transfer function analysis was applied to derive autoregulatory parameters of gain, phase difference (PD), and autoregulation index. Results The PD in migraineurs with RLS was 50.6?±22.9?, which was significantly lower than that observed in the non-RLS group (67.2?±18.2?, P <0.001). The PD in the large RLS group (45.4?±22.6?) was significantly lower than that of the small RLS group (64.9?±17.1?, P <0.01) and non-RLS group (P <0.001); however, the PD in the small RLS group was similar to that of the non-RLS group. The PD in the permanent group (48.8?±19.9?) was similar to that of the latent group (52.6?±26.1?), and both were significantly lower than that of the non-RLS group (P <0.05). The autoregulation index results were similar to the PD findings. Conclusion dCA is impaired in migraineurs with large RLS, and this may represent a potential mechanism linking RLS, migraine, and cryptogenic stroke.

Key words: Dynamic cerebral autoregulation; Migraineurs; Right-to-left shunts; Cryptogenic stroke

摘要：

目的 右向左分流（right-to-left shunts，RLS）与偏头痛和隐源性卒中之间的关系目前尚未明确。动态 脑血流自动调节（dynamic cerebral autoregulation，dCA）受损可能在偏头痛和隐源性卒中的发生发展过 程中起着重要的作用，本研究旨在探讨RLS是否与dCA受损有关。 方法 本研究共纳入66例偏头痛患者，其中36例无RLS，30例有RLS。采用经颅多普勒超声连续监测 患者的脑血流速度，同时采用无创手指血压连续监测仪实时同步监测动脉血压。利用传递函数分析 得出以下脑血流自动调节参数：增益、相位差（phase difference，PD）和自动调节指数（autoregulation i ndex，ARI ）。 结果 RLS组偏头痛患者的PD为50.6°±22.9°，明显低于无RLS组（67.2°±18.2°，P <0.001)。大量分 流组的PD（45.4°±22.6°）明显低于少量分流组（64.9°±17.1°，P <0.01）和无RLS组（P <0.001）；然 而，少量分流组与无RLS组的PD值差异无显著性。RLS固有分流组的PD值（48.8°±19.9°）与潜在分流 组（52.6°±26.1°）差异无显著性，但都明显低于无RLS组（P <0.05）。ARI 结果与PD一致。 结论 伴有大量RLS的偏头痛患者dCA受损，这也许是联系RLS、偏头痛和隐源性卒中的潜在机制。

关键词: 脑血流自动调节; 偏头痛; 右向左分流; 隐源性卒中