脑梗死后乏氧组织长时间存在的意义探讨  

The significance of long-term existence of hypoxic tissue after cerebral infarction

作　　者：王艺东[1] 黎祥喷[1] 李梅[1] 刘生[2] 卢献平[2] 彭英[1] 黄如训[3] 

机构地区：[1]中山大学附属第二医院神经科,广州510120 [2]中山大学附属第二医院核医学科,广州510120 [3]中山大学附属第一医院神经科

出　　处：《中国实用医药》2009年第24期5-7,共3页China Practical Medicine

基　　金：教育部"211"工程基金资助项目(项目编号:98061)

摘　　要：目的本研究通过观察脑梗死后长时间存在的乏氧组织与患者病情、预后的关系,探讨其意义。方法46例起病14 d内的完全或部分前循环梗死的患者,行99mTc-HL91 SPECT脑乏氧显像及同机CT扫描。在乏氧显像当天和起病21 d行美国国立卫生研究院卒中量表(NIHSS)评分,在起病30 d和90 d行修订的Barthel指数(MBI)和修订的Rankin量表(MRS)评分。比较乏氧显像阳性与阴性患者的NIHSS、MBI、MRS评分,分析乏氧组织体积与这些评分的相关性。结果①30例患者乏氧阳性;②乏氧显像时NIHSS评分值及其与起病21 d时的NIHSS评分的差值在乏氧阳性与阴性者之间有统计学意义的差异(P=0.04,0.00)。该差值与乏氧组织体积和脑梗死亚型呈线性关系(β=0.02,1.58;P=0.02,0.03);③乏氧组织体积与起病90 d MBI、MRS评分呈等级相关性(r=0.39,P=0.03;r=-0.39,P=0.03)。乏氧组织体积与起病90 d MRS评分呈线性关系(β=-0.01;P=0.02)。结论脑梗死后存在的乏氧组织可作为估计患者早期病情好转的一个新指标,而且可能有助于预后的改善。Objective To evaluate the relationship between the long-term existence of hypoxic tissue and severity or prognosis in patients with cerebral infarction. Methods Forty-six patients with total or partial anterior circulation infarct underwent 99mTc-HL91 SPECT and CT scans within 14 days after onset. The severity of the neurological deficit was assessed at the time of hypoxic imaging and at the 21st day of onset using the National Institute of Health stroke scale（NIHSS） ,and functional outcome was evaluated using the modified Barthel Index（MBI） and the modified Rankin Score（MRS） approximately 30 and 90 days after stroke. The scores on NIHSS, MBI and MRS between patients with positive and negative hypoxic imaging were compared and the correlations between hypoxic volume and the scores were analyzed. Results Thirty patients showed positive hypoxic imaging. The NIHSS scores at the time of hypoxic imaging and the margins of NIHSS score from the time of hypoxic imaging to 21 days of stroke onset were significantly different between patients with positive and nega- tive imaging （ P = 0. 04, 0. 00） , and the margins were significantly correlated with the volume of hypoxic tissue and the type of cerebral infarction （ β = 0. 02, 1.58 ; P = 0. 02, 0. 03 ）. There was a correlation between hypoxic volume and the MBI or MRS scores at day 90 （ r = 0. 39, P = 0. 03 ; r = -0. 39, P = 0. 03 ） and a linear relation between hypoxic volume and the MRS scores at day 90 （β = -0. 01 ; P = 0. 02）. Conclusion Hypoxic tissue can be a new sign that assesses improvement in an early phase and may help to improve clinical outcomes after cerebral infarction.

关 键 词：脑梗死 乏氧 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]