| Objective:To evaluate the change and significance of regional cerebral blood flow(rCBF)in adult patients with ischemic moyamoya disease in different blood pressure conditions by applying the single-photon emission computed tomography(SPECT).Methods:A total of 154 patients with ischemic moyamoya disease admitted to the Department of Neurosurgery of Henan people's Hospital from March 2018 to September 2018 were examined,including detailed medical history,clear stage of moyamoya disease,24 hours ambulatory blood pressure,cardiopulmonary function and NIHSS score.43 patients who met conditions were selected according to the inclusion / exclusion criteria and were randomly divided into two groups: RHBP group(relative high blood pressure group)and RLBP group(relative low blood pressure group).In both groups,patients performed SPECT for the first time in resting state,and the low perfusion area was determined by visual evaluation.The most obvious level was selected to record the semi-quantitative value of radionuclide imaging in the blood supply area of bilateral middle cerebral artery.Then,at the same time on the next day or the third day,the RHBP group increased BP by exercise load(10%-15% higher than basal MAP),the RLBP group decreased BP by drugs(10%-15% decreased compared with basal MAP).Under the same conditions,SPECT was performed again,and the same site was selected for the first time to record the semi-quantitative value of radionuclide imaging in the blood supply area of bilateral middle cerebral artery and performed the statistical analysis.Results:In the RHBP experiment,there were 22 patients with a male-to-female ratio of 0.83(10 /12).The average age was 43.3 ±9.3 years old.The first symptoms were transient ischemic attack(n = 13),asymptomatic(n = 2)and dizziness / headache(n = 7).There are 264 ROI regions in 22 patients,which can be divided into A,B,C1 and C2 according to the brain perfusion.Type A is defined as perfusion defect in resting state,with a total of 23 regions.The rCBF in resting state was 37.00%(2.37%),and that after intervention was 38.17%(2.26%).The difference was not statistically significant.(P =0.10).Type B was defined as decreased perfusion in resting state,with a total of 138 regions.The rCBF in resting state was 78.26%(3.52%),and increased to 86.70%(4.57%)after intervention.Type C1 was defined as normal perfusion in resting state,with a total of 94 regions.The rCBF in resting state was 87.94%(1.96%).and after intervention,the rCBF increased to 94.26%(1.79%).The difference was statistically significant(P<0.01).C2 was also defined as normal perfusion in resting state,a total of 9 regions,the rCBF in resting state was 90.67%(2.98%),and the rCBF was 93.11%(2.85%)after intervention,the difference was not statistically significant(P =0.113).There were 44 hemispheres in 22 patients,According to Suzuki staging,there were 7 cases of stage ?,8 cases of stage ?,20 cases of stage ?,8 cases of stage ? and 1 case of stage ?.The ratio S increased with the increase of stage,and there was significant difference between stage ? and stage ? / ?(P <0.05),but there was no significant difference between the other two groups.In the RLBP experiment,there were 21 patients with a male-to-female ratio of 1.1(11 /10),and the average age was 42.9 ±7.7 years old.The first symptoms were transient ischemic attack(n = 8),asymptomatic(n = 3)and dizziness / headache(n = 10).There are 251 ROI regions in 21 patients,which can be divided into A,B and C types according to the perfusion.Type A is defined as perfusion defect in resting state,with a total of 17 regions.The rCBF in resting state was 36.24%(1.00%),and the rCBF was 35.59%(1.03%)after intervention,and the difference was not statistically significant(P =0.94).Type B was defined as decreased perfusion in resting state,with a total of 148 regions.The rCBF in resting state was 79.20%(2.70%),and the rCBF decreased to 69.54%(3.14%)after intervention.Type C1 was defined as normal perfusion in resting state,with a total of 87 regions.And the rCBF in resting state was 88.49%(2.85%),after intervention,the rCBF decreased to 77.87%(3.20%).The difference was statistically significant(P<0.01).There were 42 hemispheres in 21 patients,According to Suzuki staging,there were 6 cases of stage ?,10 cases of stage ?,11 cases of stage ? and 15 cases of stage ?.The ratio S increased with the increase of stage,and there was significant difference between stage ? and stage ? / ?/?(P <0.05),but there was no significant difference between the other two groups.The ?MAP% in RHBP experiment was 11.18%(2.93% in),and in RLBP experiment,?MAP% was 11.74%(2.88%).After excluding the type A(perfusion defect ROI areas)in the two experiments,the statistical analysis of 241 ROI in the remaining RHBP experiment and 235 ROI in the RLBP experiment showed that the ?rCBF% in the RHBP experiment was 9.26%(3.24%),and in RLBP experiment,the ?rCBF% was 12.12%(2.68%),the difference was statistically significant(P <0.05).The ratio S in RHBP experiment was 0.83(0.30),which was lower than that in RLBP experiment,and the difference was statistically significant(P <0.05).In addition,a large degree of dispersion of the two experimental midpoints can also be found in the box-plot,suggesting that the ability of cerebrovascular autoregulation may show some differences in different regions and different individuals.Conclusion:1.The application of SPECT can not only comprehensively evaluate the cerebral perfusion of patients with moyamoya disease,but also evaluate the ability of cerebrovascular autoregulation to some extent after the change of blood pressure.2.The rCBF in patients with ischemic moyamoya disease showed strong pressure-passivity,and a small change in blood pressure could cause significant changes in rCBF,suggesting that the ability of cerebrovascular autoregulation in patients with moyamoya disease was impaired.3.Increasing BP can increase rCBF in decreased perfusion area to some extent.It is suggested that the local perfusion can be improved by properly raising BP.4.The cerebrovascular autoregulation ability of patients with moyamoya disease was different in different Suzuki stages,and decreased with the increase of stages.5.The change rate of rCBF after BP reduction is more obvious than that after increase BP,and the ratio S(?rCBF/? MAP)during decrease BP is also higher than that during increase BP,which may suggest that cerebrovascular autoregulation shows a better buffer capacity when coping with the increase of blood pressure compared with lower blood pressure,and show stronger pressure-passivity in the process of blood pressure decrease,which can provide some implications for perioperative blood pressure management. |
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