The influence of dynamic cerebral autoregulation efficiency on its directional sensitivity.

IF 2.3 3区 医学 Q3 PHYSIOLOGY
Ronney B Panerai, Aaron Davies, Victoria J Haunton, Abdulaziz Alshehri, Emmanouil Katsogridakis, Lucy C Beishon, Thompson G Robinson, Jatinder S Minhas
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引用次数: 0

Abstract

Dynamic cerebral autoregulation (dCA) demonstrates directional sensitivity (DSCA), depending on increases or reductions in mean arterial blood pressure (MAP). DSCA dependence on the efficiency of dCA has not been reported. A retrospective study of 172 healthy subjects (88 female, age 19-82 years), with five-minute recordings of MAP, cerebral blood velocity (middle cerebral artery, MCAv), end-tidal CO2, and electrocardiogram, led to estimates of the MCAv step response to changes in MAP. The strength of DSCA was expressed by the difference between the MCAv step responses for the positive derivative component of MAP and the corresponding negative derivative component. The efficiency of dCA was expressed by the original autoregulation index (ARIorig), ranging from 0 to 9, calculated from the original MAP. For the entire population, DSCA strength was not associated with ARIorig, or any other parameters. However, when taking biological sex and age into account, markers of DSCA strength showed significant linear regressions with ARIorig, with negative slopes for younger females (p=0.0037 to 0.011, late phase of the step responses), no influence in older females (p> 0.69), and positive slopes for both younger and older males (early phase of the step responses, p=0.003 to 0.041). This contrasting pattern of the influences of sex and age is in agreement with the known effects of gonadal hormones on the myogenic response and endothelial function of the cerebral circulation. Clinical studies of the diagnostic and/or prognostic value of DSCA parameters need to take into account the influences of sex, age and the ARIorig.

动态脑自调节效率对其方向敏感性的影响。
动态脑自动调节(dCA)表现出方向敏感性(DSCA),取决于平均动脉血压(MAP)的升高或降低。DSCA对dCA效率的依赖尚未见报道。对172名健康受试者(88名女性,年龄19-82岁)进行回顾性研究,记录5分钟的MAP、脑血流速度(大脑中动脉,MCAv)、潮末CO2和心电图,估计MCAv对MAP变化的阶跃反应。DSCA的强度由MAP的正导数分量和相应的负导数分量的MCAv阶跃响应之差来表示。dCA的效率由原始的自调节指数(ARIorig)表示,范围从0到9,由原始MAP计算得出。对于整个群体,DSCA强度与ARIorig或任何其他参数无关。然而,当考虑到生理性别和年龄时,DSCA强度的标记与ARIorig呈显著的线性回归,年轻女性的斜率为负(p=0.0037至0.011,阶梯反应后期),对老年女性没有影响(p= 0.69),年轻和老年男性的斜率均为正(阶梯反应早期,p=0.003至0.041)。这种性别和年龄影响的对比模式与已知的性激素对肌肉生成反应和脑循环内皮功能的影响是一致的。临床研究的诊断和/或预后价值的DSCA参数需要考虑到性别,年龄和性别的影响。
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来源期刊
CiteScore
5.30
自引率
3.60%
发文量
145
审稿时长
2 months
期刊介绍: The American Journal of Physiology-Regulatory, Integrative and Comparative Physiology publishes original investigations that illuminate normal or abnormal regulation and integration of physiological mechanisms at all levels of biological organization, ranging from molecules to humans, including clinical investigations. Major areas of emphasis include regulation in genetically modified animals; model organisms; development and tissue plasticity; neurohumoral control of circulation and hypertension; local control of circulation; cardiac and renal integration; thirst and volume, electrolyte homeostasis; glucose homeostasis and energy balance; appetite and obesity; inflammation and cytokines; integrative physiology of pregnancy-parturition-lactation; and thermoregulation and adaptations to exercise and environmental stress.
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