《Real-time TCD-vEEG monitoring for neurovascular coupling in epilepsy》

（Seizure Volume 29, July 2015, Pages 1-3）

【A B S T R A C T】

Purpose: Recently, a novel multi-model monitor has been available, which integrates real-time signals of transcranial Doppler (TCD) and video-EEG (vEEG) 【NSD-8100，Delica，China】into one workstation. We sought to test the feasibility of this device in detecting neurovascular coupling in patients with epilepsy.

Method: Cerebral blood flow velocity (CBFV) of bilateral middle cerebral arteries and vEEG during seizure episodes were recorded simultaneously in 12 patients (age 17–58 years) with partial epilepsies. The correlations between vEEG and CBFV findings were analyzed.

Results: Eleven seizure episodes were detected in 5 patients. Of them, bilateral CBFV increase with interhemispheric asymmetry was observed in 4 seizure episodes of 3 patients. EEG abnormalities preceded CBFV increase by 1–3 s at the onset of a seizure. In a patient with bilateral middle cerebral artery stenosis, no apparent CBFV changes were detected during 2 of 3 seizure episodes. Another patient with previous frontal hemorrhage displayed CBFV increase without interhemispheric asymmetry during 4 seizure episodes.

Conclusion: It is feasible to evaluate neurovascular coupling with good temporal correlation in patients with frequent seizure episodes by real-time TCD-vEEG monitoring.

《Transcranial Doppler combined with quantitative EEG brain function monitoring and outcome prediction in patients with severe acute intracerebral hemorrhage》

（Chen et al. Critical Care (2018) 22:36）

【A B S T R A C T】

Background: Neurological deterioration after intracerebral hemorrhage (ICH) is thought to be closely related to increased intracranial pressure (ICP), decreased cerebral blood flow (CBF), and brain metabolism. Transcranial Doppler(TCD) is increasingly used as an indirect measure of ICP, and quantitative EEG (QEEG) can reflect the coupling of CBF and metabolism. We aimed to combine TCD and QEEG to comprehensively assess brain function after ICH and provide prognostic diagnosis.

Methods: We prospectively enrolled patients with severe acute supratentorial (SAS)-ICH from June 2015 to December 2016. Mortality was assessed at 90-day follow-up. We collected demographic data, serological data, and clinical factors, and performed neurophysiological tests at study entry. Quantitative brain function monitoring was performed using a TCD-QEEG recording system at the patient’s bedside (NSD-8100; Delica, China). Univariate and multivariable analyses and receiver operating characteristic (ROC) curves were employed to assess the relationships between variables and outcome.

Results: Forty-seven patients (67.3 ± 12.6 years; 23 men) were studied. Mortality at 90 days was 55.3%. Statistical results showed there were no significant differences in brain symmetry index between survivors and nonsurvivors, nor between patients and controls (all p > 0.05). Only TCD indicators of the pulsatility index from unaffected hemispheres (UPI) (OR 2.373, CI 1.299–4.335, p = 0.005) and QEEG indicators of the delta/alpha ratio (DAR) (OR 5.306, CI 1.533–18.360, p = 0.008) were independent predictors for clinical outcome. The area under the ROC curve after the combination of UPI and DAR was 0.949, which showed better predictive accuracy compared to individual variables.

Conclusions: In patients with SAS-ICH, multimodal neuromonitoring with TCD combined with QEEG indicated that brain damage caused diffuse changes, and the predictive accuracy after combined use of TCD-QEEG was statistically superior in performance to any single variable, whether clinical or neurophysiological。

《顱內(nèi)動(dòng)脈重塑研究進(jìn)展：從局灶性到普遍性重塑》

（中國(guó)實(shí)用內(nèi)科雜志 2017 年 11 月第 37 卷第 11 期）

【摘要】

近年來(lái)學(xué)者們逐漸認(rèn)識(shí)到動(dòng)脈是一個(gè)活躍的器官，會(huì)隨多種病理生理情況發(fā)生重塑。從早期冠心病和周圍血管粥樣硬化所致的局灶性動(dòng)脈重塑，到近年來(lái)報(bào)道的普遍性動(dòng)脈重塑。文章綜述了顱內(nèi)動(dòng)脈重塑定義、分類，研究測(cè)量方法，重塑機(jī)制及與臨床癥狀疾病的關(guān)系。

【主要內(nèi)容】

1、顱內(nèi)動(dòng)脈重塑的定義

動(dòng)脈在不同的生理和病理?xiàng)l件下可向內(nèi)收縮或

向外擴(kuò)張，即動(dòng)脈重塑(arterial remodeling) 。當(dāng)顱內(nèi)動(dòng)脈產(chǎn)生上述現(xiàn)象即為顱內(nèi)動(dòng)脈重塑。

2 顱內(nèi)動(dòng)脈重塑的測(cè)量研究方法

目前動(dòng)脈重塑的研究大都是橫斷面研究，難以動(dòng)態(tài)觀察病灶處動(dòng)脈重塑。采用比較斑塊處血管管周面積和臨近管腔相對(duì)正常處血管管周面積的方法來(lái)衡量斑塊處動(dòng)脈重塑的情況。

研究者廣泛使用重塑率(remodeling ratio，RR) 來(lái)判定動(dòng)脈重塑：RR ＝病灶處管周面積/ 參照點(diǎn)管周面積；RR>1.05 為擴(kuò)張性重塑，RR<0.95 為縮窄性重塑，0.95<RR<1.05為無(wú)重塑。此測(cè)量方法也有一定局限性，由于血管從近端至遠(yuǎn)端是逐漸變細(xì)的，參照點(diǎn)取近端可能會(huì)低估RR，參照點(diǎn)取遠(yuǎn)端可能會(huì)高估RR。Qiao等 在矯正了顱內(nèi)動(dòng)脈測(cè)量點(diǎn)間距離和血管變細(xì)的因素后計(jì)算了RR。另一方面，在所研究血管可能無(wú)法找到完全不受動(dòng)脈粥樣硬化影響的正常參照點(diǎn)。

目前在研究顱內(nèi)動(dòng)脈的普遍性重塑上，測(cè)量評(píng)價(jià)方法還沒(méi)有達(dá)成共識(shí)。

3 顱內(nèi)動(dòng)脈重塑的機(jī)制

顱內(nèi)動(dòng)脈重塑的機(jī)制及病理生理改變還不是十分明確。有限的關(guān)于周圍動(dòng)脈的研究表明，血流動(dòng)力學(xué)、 體液因子及炎癥與動(dòng)脈重塑相關(guān)。血管內(nèi)皮接收信號(hào)傳輸給臨近細(xì)胞，導(dǎo)致一系列影響細(xì)胞生長(zhǎng)、凋亡、遷移和細(xì)胞外基質(zhì)生成或激活的活動(dòng)。需要強(qiáng)調(diào)的是，在不同的病理生理情況下，參與動(dòng)脈重塑的主要機(jī)制可能是不同的。

4 顱內(nèi)動(dòng)脈重塑的臨床意義

動(dòng)脈重塑是決定管腔大小的重要因素。在形態(tài)學(xué)上，擴(kuò)張性重塑減輕管腔狹窄，縮窄性重塑加重管腔狹窄。組織學(xué)上，擴(kuò)張性重塑與易損斑塊相關(guān)，斑塊成分有更大的脂質(zhì)核心、炎癥和薄纖維帽；縮窄性重塑與穩(wěn)定斑塊并存，斑塊有小的脂質(zhì)核心和更多纖維等等。

5 總結(jié)

動(dòng)脈重塑是一種常見(jiàn)的在多種生理、病理情況下，血管反應(yīng)性向外擴(kuò)張或向內(nèi)收縮的現(xiàn)象。顱內(nèi)動(dòng)脈重塑分為在動(dòng)脈粥樣硬化斑塊處的局灶性重塑，及沿整個(gè)血管節(jié)段的普遍性重塑。關(guān)于重塑的病理生理機(jī)制和普遍性重塑的研究還很缺乏，需要進(jìn)一步的研究來(lái)系統(tǒng)闡述重塑類型的分布規(guī)律及臨床意義。研究動(dòng)脈重塑可能對(duì)血管病的病例生理有更深入的認(rèn)識(shí)，對(duì)患者個(gè)體化精準(zhǔn)治療有潛在意義。