| Background and objective: Cerebral small vessel disease is the common cause of stroke and the main cause of vascular dementia.Lacunar infarction is one of the main characteristics of cerebral small vessel disease.Lacunar accounts for approximately 25% of all types of ischemic stroke.Dynamic cerebral autoregulation is impaired during the acute and subacute stages of ischemic stroke.d CA damage is associated with poor prognosis.Studies have pointed out that the characteristics of impaired d CA in ischemic stroke are related to the subtypes of stroke.The purpose of this study was to explore the characteristics of d CA changes in patients with acute lacunar infarction and its relationship with clinical prognosis.Methods: In this study,a total of 69 patients with acute lacunar infarction who met the admission and discharge criteria were included in the Stroke Unit of the First Hospital of Jilin University from February 2017 to January 2020,and 42 healthy subjects with matched age and gender were included as the control group.Transcranial Doppler ultrasound was used to continuously monitor the cerebral blood flow velocity of the subjects’ middle cerebral artery.Arterial blood pressure(ABP)was monitored synchronously by non-invasive blood pressure monitor.According to the spontaneous fluctuation of blood pressure and cerebral blood flow in resting state,d CA parameters,including phase,gain,rate of recovery,and autoregulation index,were calculated by transfer function analysis.The obtained d CA parameters were compared with the healthy control group.The relationship between d CA parameters and clinical prognosis was analyzed by binary logistic regression analysis.Results: d CA parameters of bilateral cerebral hemispheres in lacunar stroke group were significantly different from those in healthy control group,which were mainly characterized by very low frequency and low frequency phase reduction(all P < 0.05).There was no significant difference in d CA parameters between the infarcted side and the contralateral side of the lacunar stroke group(all P>0.05).d CA parameters of lacunar stroke group had no significant difference in acute and subacute stages(P>0.05).Very low frequency phase(all P <0.001),low frequency phase(all P <0.05)in poor prognosis group was significantly lower than that in good prognosis group.After adjusting for age,gender and discharge NHISS score,the very low frequency phase of lacunar stroke patients in acute stage infarcted side <51.86° was an independent risk factor of poor prognosis at 3 months of onset(adjusted OR=18.88,95% confidence interval: 3.04 to 116.91,P=0.002).Conclusions: d CA was impaired bilaterally in lacunar stroke patients,and there was no difference in d CA impairment between the infarct side and the contralateral side.Impair of d CA in lacunar stroke patients is associated with poor prognosis.Very low frequency phase on the side of infarction in lacunar stroke patients in acute phase <51.86° may be an independent risk factor of poor prognosis at 3 months in patients of lacunar stroke. |
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