【作者】 张然；

【导师】 王赞；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2017， 硕士

【摘要】 目的:本研究旨在明确中枢性睡眠增多患者动态脑血流自动调节的变化,并探讨其可能作用的病理生理机制,为指导临床治疗提供更多依据。方法:本研究选取2016年2月到2017年2月期间就诊于吉林大学第一医院神经内科门诊的符合日间过度嗜睡的诊断标准的研究对象21例及健康对照组7例,根据夜间睡眠监测加多次睡眠潜伏期试验检查结果将实验组分为嗜睡组7例、发作性睡病不伴RBD组7例、发作性睡病伴RBD组7例。应用经颅多普勒超声联合连续指尖血压检测仪,无创地同步记录脑血流速度(CBFV)和动脉血压,采用目前公认的传递函数分析(TFA)方法计算导出脑血流自动调节参数:相位差(PD)、增益、相关性,评价脑血流自动调节功能。在发作性睡病患者中,有7例经过至少1个月规范治疗后再次行脑血流调节检查,并与治疗前进行比较。结果:(1)嗜睡组、发作性睡病不伴RBD组、发作性睡病伴RBD组ESS(14.6±3.8、16.4±4.0、18.0±2.9)与对照组数值(2.1±1.3)比较均明显升高,差异均有统计学意义(p<0.05)。嗜睡组、发作性睡病不伴RBD组、发作性睡病伴RBD组左相位差(33.97±8.71、35.49±11.72、32.00±13.09)与对照组数值(53.15±7.91)比较均明显下降;嗜睡组、发作性睡病不伴RBD组、发作性睡病伴RBD组右相位差(33.95±9.21、36.58±13.30、31.85±8.77)与对照组数值(53.54±10.87)比较均明显下降,不同组别研究对象的左右相位差差异均有统计学意义(p<0.05)。不同组别研究对象的左右增益差异均无统计学意义(p>0.05)。发作性睡病伴RBD与不伴RBD相应半球的相位差、增益相比,差异均无统计学意义(p>0.05)。(2)发作性睡病治疗前后相比,治疗后ESS(11.3±2.0)较治疗前ESS(15.6±2.7)降低,其差异具有统计学意义(p<0.05);治疗后左侧PD(43.9±12.54°)与治疗前左侧PD(24.79±10.13°)相比,PD差异显著增加,差异具有显著统计学意义(p<0.05)。治疗后右侧PD(43.05±14.89°),与治疗前左侧PD(25.39±5.50°)相比,PD差异显著增加,具有统计学意义(p<0.05),而治疗前后的左右增益差异均无统计学意义(p>0.05)。结论:(1)中枢性睡眠增多患者的动态脑血流自动调节功能受损。(2)对于发作性睡病伴RBD与不伴RBD的患者,动态脑血流自动调节功能受损程度无差异,可能有相同的病理生理机制有关。(3)经药物(哌甲酯、氟西汀或文拉法辛)治疗后发作性睡病患者的动态脑血流自动调节功能有所改善。更多还原

【Abstract】 Objective: The purpose of this study was to observe the changes of the dynamic cerebral autoregulation in patients with central disorders of hypersomia,and to discuss the possible pathophysiological mechanisms so that we can provide more evidence for the clinical treatment of central hypersomia.Method: In this study,patients with excessive daytime sleepiness during the period from February 2016 to February 2017 were enrolled as experimental group in the Department of Neurology,No.1 Hospital of Jilin University,21 cases were followed up and 7 cases were enrolled as healthy control group.According to the results of the PSG and MLST,it was divided into hypersomia group、narcolepsy without RBD group、narcolepsy with RBD group,each group has 7 cases.Non-invasive continuous cerebral blood flow velocity(CBFV)and arterial blood pressure were recorded simultaneously using a transcranial Doppler device and a servo-controlled plethysmograph,respectively.Transfer function analysis was used to derive the autoregulatory parameters including phase difference(PD),gain,to evaluate the d CA function.In the patients with narcolepsy,7 patients were treated with cerebral blood flow regulation after standardized treatment for 1 months,and compared with before treatment.Result:(1)Compared with the ESS score(2.1 ± 1.3)of control group,hypersomia group,narcolepsy without RBD group narcolepsy with RBD group ESS score(14.6±3.8,16.4±4,18±2.9)were significantly increased,the differences were statistically significant(p< 0.05).(2)The left phase difference of hypersomia group,narcolepsy without RBD group narcolepsy with RBD group(33.97±8.71、35.49±11.72、32.00±13.09)were lower than that of the control group(53.15 ± 7.91),the right phase difference of hypersomia group,narcolepsy without RBD group narcolepsy with RBD group(33.95±9.21、36.58±13.30、31.85±8.77)were lower than that of the control group(53.54±10.87),left and right phase research object of different groups had significant difference(p < 0.05).But there were no significant differences in the left and right gains between subjects in different groups(p>0.05).There was no significant difference between the corresponding hemisphere PD(p > 0.05)of the narcolepsy without RBD group and with RDB group;and there was no significant difference in the corresponding hemisphere gain(p> 0.05).(2)Compared the ESS of Narcolepsy patients before and after treatment,the ESS score after treatment(11.3 ± 2)was decreased than before treatment ESS(15.6 ± 2.7),the difference was significant(p< 0.05);Compared with left PD(24.79±10.13°)before the treatment,the after treatment of narcolepsy patients left PD(43.9 ± 12.54 °)increased significantly,the difference was significant(p < 0.05);After treatment,the right PD(43.05±14.89°)was significantly increased compared with that of the left PD(25.39±5.50°)before treatment,and the difference was significant(p < 0.05).There was no significant difference in the gain of the cerebral hemisphere in patients with narcolepsy before and after treatment(p> 0.05).Conclusion:(1)The d CA dysfuntion was happened in patients with central disorders of hypersomnia.(2)There is no difference in the degree of dynamic cerebral blood flow in the patients of narcolepsy with RBD and without RBD,which may have the same pathophysiological mechanism.(3)The d CA was improved in patients with narcolepsy after drug(Metylphenidate /Fluoxetine/Venlafaxine)treatment.更多还原