尿激酶静脉溶栓治疗急性脑梗死磁共振弥散加权成像实验研究  

An Evaluation of Intra-venous Thrombolytic Therapy Using Urokinase by Magnetic Resonance Diffusion-weighted Image Method

作　　者：易黎[1] 张海鸥[1] 

机构地区：[1]北京大学深圳医院神经内科,广东深圳518036

出　　处：《中国神经免疫学和神经病学杂志》2005年第6期357-358,362,共3页Chinese Journal of Neuroimmunology and Neurology

基　　金：深圳市科技计划基金资助项目(200404092)

摘　　要：目的利用自体血栓栓塞大脑中动脉模型,通过弥散加权成像(diffusion-weighted imaging,DWI)等影像学信息评价不同时间点尿激酶静脉溶栓治疗急性脑梗死的疗效可行性。方法健康SD大鼠32只随机分为A、B组,每组16只。颈内动脉注入自凝血栓子制成急性脑梗死动物模型。A组栓塞后30 min、B组栓塞60 min分别经股静脉给予尿激酶溶栓。于栓塞各时间点及溶栓后3、24 h行DWI、T2WI、T2*W扫描;计算各时间点DWI上缺血区体积,缺血区相对平均信号强度值(relative mean signal intensity,RMSI)。结果A组治疗后3 h观察结果显示,再通率37.5%(6/16),缺血区体积较治疗前明显减少,但缺血区信号强度增高;24 h观察结果显示,DWI高信号区体积有增大趋势。B组治疗后3 h观察结果显示,仅有18.8%获得再通,缺血区体积较溶栓前无明显变化,DWI显示脑水肿明显,缺血区信号强度增高,24 h时该组动物全部死亡。结论在脑梗死早期适当的“治疗窗”内制定个体化溶栓治疗方案可显著减少梗死范围,DWI是缺血极敏感的影像技术,对诊断和科学监测脑卒中溶栓治疗效果及疾病转归有重要意义。此所用实验模型的“溶栓治疗窗”可限定于缺血后30 min内,而缺血60 min则预后不良。Objective To study the thrombolytie effect of intra-venous treatment by using urokinase during the acute cerebral infarction with magnetic resonance diffusion-weighted imaging （DWI） in a clot emboli occlusion model of middle cerebral artery （MCAO）. Methods 32 healthy SD rats with MCAO by clot emboli were divided randomly into two groups. Group A （16 rats）, occluded with clot embolus for 30 minutes; Group B （16 rats）, occluded with clot embolus for 60 minutes. After the successful operation, the UK was injected in the 30 minutes, 60 minutes respectively. The DWI, T2WI,T2＊W was scanned for all two groups in the 3, 24 h after the injection. The relative mean signal intensity （RMSI） and the volume of regions of hyperintensity signal in DWI were calculated. Results Group A received 37.5% （6/16） reperfusion in the 3 h observation. The ischemia area was reduced evidently. But the RMSI was raised in that region. The volume of hyperintense signal in DWI was found to increase in 24 h. In the Group B, the reperfusion was only 18.8%. The volume of isehemia regions had no significant change after the injection. The edema was serious in DWI; RMSI was much stronger than that before the injection. The animals were all died in this group. Conclusions The ischemia area was markedly reduced in the acute cerebral infarction by making the individual thrombolytic case behind the “time window”. DWI has good sensitivity to acute cerebral ischemia, which can be used to diagnose and monitor the acute thrombolytic treatment and final outcome. The “therapy window” was limited in 30 min in this experimental model. The outcome was bad if the treatment was done after 60 min ischemia.

关 键 词：脑梗死 尿激酶 溶栓 磁共振弥散加权像 

分 类 号：R743[医药卫生—神经病学与精神病学]