脑梗死患者磁共振表观扩散系数演变的临床价值  

Time Course of Apparent Diffusion Coefficient Changes in Diffusion Weighted Magnetic Resonance Imaging for Cerebral Infarction

作　　者：钟水生 谭盛[2] 潘梦秋 王展航 

机构地区：[1]广东三九脑科医院神经内科,广州510510 [2]南方医科大学第二临床医学院珠江医院神经内科,广州510282

出　　处：《血栓与止血学》2015年第4期193-197,共5页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的通过分析脑梗死患者磁共振(MRI)弥散加权成像(DWI)表观扩散系数(ADC)值的变化,探讨脑梗死不同时期脑水肿的变化规律及相应水肿期丁苯酞软胶囊疗效。方法选取2013年1月~2014年6月期间收治的脑梗死并行磁共振DWI检查的病例269例,采集脑梗死后超早期(≤6 h)、急性期(6~24 h)、坏死期(24~48 h)、软化期(48 h^3 W)ADC值变化,筛选出58例服用丁苯酞软胶囊患者,分为<48 h组(30例)、>48 h组(28例),进行NIHSS评分(National Institute of Health Stroke Scale)。结果急性脑梗死超早期、急性期、坏死期及软化期病灶侧ADC均值分别为0.524±0.080,0.401±0.081,0.369±0.084、0.524±0.100,坏死期与其它期比较,ADC值均明显下降(P<0.001)。同时,<48 h、>48 h组患者,治疗后NIHSS评分〔4.97±2.414 vs.8.46±3.061〕较治疗前(10.50±3.684 vs.11.32±1.375〕明显降低(P<0.001〕,治疗2周后<48 h组NIHSS评分较>48 h组明显改善(P<0.001)。结论 ADC可反映脑梗死细胞毒性水肿向血管源性水肿的演变过程,丁苯酞软胶囊治疗脑梗死能改善神经功能缺损,48 h之内治疗效果优于48 h后。Objective To evaluate the apparent diffusion coefficient（ADC） changes at the stroke onset. And study the effect of butylphthalide soft capsule in the treatment of cerebral infarction. Methods Retrospective study（2013.1-2014.6） consist of 269 patients （ 16 Ultra early ;75 acute ;76 necrosis ; 102 softening period infarctions） were imaged with diffusion weighted imaging （DWI）. The average ADC values of the infracted lesion and contralateral normal brain were calculated respectively. 58 patients received butylphthalide soft capsule treatments within or after 48 hours after stroke happened, the NIHSS score of these two groups was analyzed after therapy for two weeks. Results The Ultra early, acute, necrosis and softening period infracted lesions show hyperintense signal on DWI. And the average of ADC value of the four stages at stroke onset were 0. 524 ±0. 080 ;0. 401 ± 0. 081 ;0. 369±0. 084 ;0.524 ± 0. 100, respectively, It shows the lowest of ADC values in the necrosis stage （24 マ 48 h）. The NIHSS score was significant lower after treatment（4.97± 2. 414 vs. 8.46 ± 3. 061 ） than before treatment（ 10.50 ± 3. 684 vs. 11.32 ± 1. 375 ） of butylphthalide soft capsule for cerebral infarction （ P 〈 0. 001 ）, and It is significant lower of NIHSS score for two weeks treatment of bu- tylphthalide soft capsule using within 48 hours stroke onset than after 48 hours. Conclusion ADC values showed similar ＂ U＂ shape change at the stroke onset, these changing maybe reflect pathological process of brain cells from cytotoxic edema to vasogenic edema evolution at different stages of cerebral infarction. And,Butylphthalide soft capsules can improve neurological deficit in cerebral infarction, especially using within 48 hours after stroke happened.

关 键 词：急性脑梗死 磁共振弥散加权成像 表观弥散系数 丁苯酞软胶囊 

分 类 号：R743.33[医药卫生—神经病学与精神病学]