急性缺血性脑卒中患者溶栓后脑血流量与缺血再灌注损伤及神经功能的相关性研究  

Correlation of cerebral blood flow after thrombolysis with ischemia-reperfusion injury and neurological function in patients with AIS

作　　者：刘春芹[1] 谭双[1] Liu Chunqin;Tan Shuang(Department of Neurology,Tangshan Workers'Hospital,Tangshan 063000,Hebei Province,China)

机构地区：[1]唐山市工人医院神经内科,063000

出　　处：《中华老年心脑血管病杂志》2024年第9期1049-1053,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河北省医学科学研究课题计划(20201489)。

摘　　要：目的 探讨急性缺血性脑卒中(acute ischemic stroke, AIS)患者溶栓后脑血流与缺血再灌注损伤及神经功能的相关性。方法 回顾性选取2021年2月至2024年2月唐山市工人医院神经内科收治的AIS患者150例,根据溶栓后CT灌注成像检查患侧脑血流量(cerebral blood flow, CBF)变化情况分为高灌注组48例和低灌注组102例。获取出血转化情况及灌注参数资料,后者包括CBF、脑血容量(cerebral blood volume, CBV)、残余功能达峰时间(time to maximum of the residual function, T_(max))、平均通过时间(mean transit time, MTT)和达峰时间(time to peak, TTP),以及相对值rCBF、rCBV、T_(r, max)、rMTT及rTTP。比较2组一般临床资料、氧化应激、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分和炎性因子水平。采用Pearson/Spearman相关性分析AIS患者溶栓后rCBF与氧化应激、炎性因子、出血转化情况及NIHSS评分的相关性。结果 低灌注组患侧MTT、T_(max)、TTP显著高于健侧,CBF显著低于健侧,差异有统计学意义(P<0.01)。高灌注组患侧MTT、TTP显著低于健侧,CBF、CBV显著高于健侧,差异有统计学意义(P<0.01)。低灌注组rMTT、T_(r, max)、rTTP显著高于高灌注组,rCBF、rCBV显著低于高灌注组(P<0.01)。低灌注组丙二醛、晚期氧化蛋白产物、肿瘤坏死因子α、C反应蛋白水平显著低于高灌注组,超氧化物歧化酶水平显著高于高灌注组,差异有统计学意义(P<0.05,P<0.01)。Pearson相关性分析显示,rCBF与丙二醛、肿瘤坏死因子α呈负相关(r=-0.436,P<0.01;r=-0.451,P<0.01),与超氧化物歧化酶呈正相关(r=0.412,P<0.01)。结论 AIS患者溶栓后脑血流变化与缺血再灌注损伤存在较好相关性,但与神经功能恢复情况不具备显著相关性。Objective To investigate the correlation of cerebral blood flow(CBF) after thrombolysis with ischemia-reperfusion(I/R) injury and neurological function in patients with acute ischemic stroke(AIS).Methods Clinical data of 150 AIS patients admitted to our department from February 2021 to February 2024 were collected and analyzed retrospectively. According to the changes in CBF in the affected side after thrombolysis, they were divided into hyperperfusion group(48 cases) and hypoperfusion group(102 cases).The condition of hemorrhagic transformation and perfusion parameters included CBF,cerebral blood volume(CBV),time to peak of residual function(T_(max)),mean transit time(MTT) and time to peak(TTP),and the relative values of regional cerebral blood flow(rCBF),rCBV,T_(r, max),rMTT and rTTP.The general clinical data, oxidative stress, NIHSS score and inflammatory factor levels were compared between the two groups.Pearson/Spearman correlation analysis was used to analyze the correlation between rCBF and oxidative stress, inflammatory factors, hemorrhagic transformation and NIHSS score in AIS patients after thrombolysis.Results In the hypoperfusion group, the MTT,T_(max) and TTP values were significantly higher, and the CBF value was obviously lower in the affected side than the healthy side(P<0.01).In hyperperfusion group, the MTT and TTP were notably lower, while the CBF and CBV were remarkably higher in the affected side than the healthy side(P<0.01).The hypoperfusion group had significantly higher rMTT,T_(r, max) and rTTP,but lower rCBV and rCBF than the hyperperfusion group(P<0.01).The levels of malondialdehyde(MDA),advanced oxidation protein products, TNF-α and C-reactive protein(CRP) were significantly lower, and the level of superoxide dismutase(SOD) was higher in the hypoperfusion group than the hyperperfusion group(P<0.05,P<0.01).Pearson correlation analysis showed that rCBF was negatively correlated with MDA and TNF-α(r=-0.436,r=-0.451,P<0.01) and positively correlated with SOD(r=0.412,P<0.01).Conclusion Th

关 键 词：卒中 血栓溶解疗法 再灌注损伤 脑血流 

分 类 号：R743.3[医药卫生—神经病学与精神病学]