CSF pressure, papilledema grade, and response to acetazolamide in the Idiopathic Intracranial Hypertension Treatment Trial
CSF pressure, papilledema grade, and response to acetazolamide in the Idiopathic Intracranial Hypertension Treatment Trial
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DOI：
10.1007/s00415-015-7838-9
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发表时间：
2015-10-01
影响因子：
6
通讯作者：
Wall, Michael
中科院分区：
文献类型：
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作者：
Kattah, Jorge C.;Pula, John H.;Wall, Michael
以往的报道表明，特发性高颅压(IIH)患者的视神经头水肿程度与脑脊液压力(CSFP)有关。我们假设CSFP可能与FRIS、n乳头水肿分级(FPG)和其他临床特征有关，并且在特发性颅内高压治疗试验(IIHTT)的参与者中，FPG将改变CSFP对乙酰唑胺的反应。在IIHTT中，符合条件的患者在登记前接受了腰椎穿刺术(LP)，并被随机分配到两个治疗组之一：乙酰唑胺加监督饮食或安慰剂+监督饮食。试验资格要求基线CSFP为千分之250毫米H2O或千分之200毫米水，并有令人信服的临床或影像IIH表现。基线时检查CSFP和空腹血糖与其他临床特征之间的关系。观察乙酰唑胺对基线空腹血糖低(I-III级)和高空腹血糖(IV-V级)患者6个月CSFP变化的影响。所有165名登记的受试者都有基线LP，85人在6个月时有LP。基线时CSFP与空腹血糖之间存在相关性：高空腹血糖受试者(378+/-A90 mm H2O，n=50)的CSFP水平高于低空腹血糖受试者(331+/-A77，n=115，p=0.002)。6个月后，乙酰唑胺对高空腹血糖受试者(-79.9 mmH2O)和低空腹血糖受试者(-50.9 mmH2O)的CSFP有相似的影响，p=0.50。我们发现CSFP和空腹血糖之间存在适度的关联。无论基线空腹血糖如何，乙酰唑胺对CSFP均有有利影响。
Previous reports suggest an association between the degree of optic nerve head edema and CSF pressure (CSFp) in idiopathic intracranial hypertension (IIH). We hypothesized that CSFp would be associated with Fris,n papilledema grade (FPG) and other clinical features, and that FPG would modify the CSFp response to acetazolamide in participants in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). In the IIHTT, eligible patients underwent lumbar puncture (LP) prior to enrollment and were randomly assigned to one of two treatment groups: acetazolamide plus supervised diet or placebo plus supervised diet. Trial eligibility required baseline CSFp a parts per thousand yen250 mm H2O or a parts per thousand yen200 mm H2O with compelling clinical or imaging IIH findings. Associations between CSFp and FPG and other clinical features were examined at baseline. The effect of acetazolamide on 6-month change in CSFp was examined in those with low FPG (grades I-III) and those with high FPG (grades IV-V) at baseline. All 165 enrolled subjects had a baseline LP and 85 had an LP at 6 months. There was an association between CSFp and FPG at baseline: CSFp was more elevated in subjects with high FPG (378 +/- A 90 mm H2O, n = 50) than in subjects with low FPG (331 +/- A 77, n = 115, p = 0.002). At 6 months, acetazolamide had a similar effect on CSFp in subjects with high FPG (-79.9 mm H2O) and in subjects with low FPG (-50.9 mm H2O, p = 0.50). We found a modest association between CSFp and FPG. Acetazolamide had a beneficial effect on CSFp regardless of baseline FPG.