高压氧治疗脑梗死脑内NAA、Lac的变化规律及与疗效的关联性研究  

A clinical analysis of variation of metabolin in brain and its applied value of patients with cerebral infarction treated with hyperbaric oxygen

作　　者：韩扬[1] 佘君慧[2] 万卫平[3] 王敏[1] 谢荭[1] 王雯[2] 汪东[3] 王罗军[2] 刘晖宇[2] 林达伟[2] 

机构地区：[1]上海市闸北区中心医院高压氧科,上海200070 [2]上海市闸北区中心医院神经内科,上海200070 [3]上海市闸北区中心医院放射科,上海200070

出　　处：《中风与神经疾病杂志》2013年第7期648-650,共3页Journal of Apoplexy and Nervous Diseases

基　　金：上海市闸北区科委;卫生局联合资助课题(2007重点-10)

摘　　要：目的观察高压氧治疗脑梗死患者脑内氮-乙酰天门冬氨酸(NAA)、乳酸(Lac)含量的变化规律,探讨与临床疗效的内在关联。方法选取神经内科收治的发病在7d内的脑梗死患者,分为高压氧治疗组(n=35)、常规治疗对照组(n=39),两组患者均于治疗前、后应用磁共振频谱(MRS)无创检测脑内NAA、Lac含量,并进行神经功能缺损程度评分,以治疗15d为数据采集时间节点,进行统计学分析。结果高压氧治疗脑梗死的疗效明显优于对照组(P<0.01);两组患者梗死区NAA明显下降、Lac显著增高符合既往文献报道的基本规律。在病程演变过程中,梗死区NAA回升缓慢,提示与病变区域发生不同程度的不可逆病理改变有关;治疗组局部Lac清除速率明显高于对照组。结论梗死区乳酸清除速率加快可能是高压氧疗效较好的机制之一;应用MRS技术检测患者NAA、Lacr变化对评估病情、研判预后均有重要的临床意义。Objective To study the variation law of N-acetyl aminosuccinic acid(NAA) 、lactic acid(Lac) in brain of patients with cerebral infarction(CI) treated with hyperbaric oxygen(HBO),and investigate its relationship with clinical therapeutic efficacy.Methods 74 cases with acute CI(admission after onset of CI in 7 days) were randomly divided into HBO treated group(35) and general treatment group(control group 39),NAA、Lac were measured with atraumatic magnetic resonance spectroscopy and neurological function deficit scores were evaluated before and after 15 days of HBO treatment.Then all dates were statistical analysised.Results In the treatment group,the effective rate was significantly higher than in the control group(P < 0.01);NAA distinctly increased and Lac markedly decreased in the infarct region in two groups.After onset of CI,NAA rebounded slowly in the infarct region suggests that it is related with the varying degrees’inconvertible pathological changes in this region.In the treatment group,the Lac-removal rate in local region was significantly higher than that in the control group.Conclusion The Lac-removal rate speeds up may be one of the effective mechanisms with HBO treatment.Measuring NAA、Lac with magnetic resonance spectroscopy is very important to estimate the degree of cerebral infarction and prognosis.

关 键 词：高压氧 脑梗死 氮-乙酰天门冬氨酸(NAA) 乳酸(Lac) 神经功能缺损程度评分 

分 类 号：R743[医药卫生—神经病学与精神病学]