摘要
目的研究临床-弥散加权不匹配（clinical—diffusion mismatch，CDM）机制在急性大脑中动脉闭塞（middle cerebral artery occlusion，MCAO）患者动脉溶栓治疗中的作用，分析CDM机制预测缺血半暗带的可行性。方法选择发病在6h内经磁共振血管成像（magnetic resonance angiography，MRA）检查证实为MCAO的急性脑梗死患者106例，其中动脉溶栓组36例，常规治疗组70例，依据CDM定义：美国国立卫生研究院卒中量表评分（NIHSS）≥8分，弥散加权成像（DWI）病灶体积≤25ml，再将两组各分为CDM亚组和非CDM亚组，对各亚组发病14d后T2加权成像（T2weightedimaging，T，WI）梗死体积、30d及3个月NIHSS评分进行对比观察。结果动脉溶栓组中，CDM亚组（n=15）NIHSS评分在病程30d、3个月均低于非CDM亚组（n=21，3．20±2．40与6．76±4．00，t=-3．330，P=0．002；2．204-1．70与6．05±4．06，t=3．895，P=0．001）；非动脉溶栓组中，CDM亚组（n=23）NIHSS评分在病程30d、3个月与非CDM亚组（n=47）比较差异均无统计学意义（5．22±2．95与5．66±3．21，t=-1．756，P=0．084；4．34±2．53与5．34±3．42，t=1．234，P=0．353）；虽然存在CDM，接受溶栓者与不接受溶栓者的NIHSS评分在30d、3个月差异均有统计学意义（3．20±2．40与5．22±2．95，t=-2．210，P=0．034；2．20±1．70与4．34±2．53，t=-3．128，P=0．003），反之，不符合CDM的患者接受与不接受溶栓治疗，NIHSS评分在30d与3个月时差异均无统计学意义。入院14d后CDM患者中溶栓组T2WI显示的梗死体积明显小于非溶栓组[（6．29±4．41）ml与（60．25±49．23）ml，Z=-4．848，P=0．001]。结论CDM机制对于确定急性MCAO脑梗死缺血半暗带的存在有一定意义，对指导急性MCAO脑梗死的动脉溶栓治疗可能有一定价值。
Objective To evaluate the function of clinical-diffusion mismatch （CDM） in intra- arterial thrombolysis treatment for acute middle cerebral artery occlusion （MCAO） and to evaluate specialty of CDM in predicting the putative penumbra. Methods All 106 acute MCAO patients within 6 hours after onset and examined by magnetic resonance angiography （MRA） were assigned into two groups： the intra- artery thrombolysis group （n = 36） and without thrombolysis group （n = 70）. Both groups were subdivided into CDM sub-group and non-CDM sub-group based on the criteria of CDM： National Institutes of Health Stroke Scale （NIHSS） score 〉18 and isehemic volume on DWI ~〈25 ml upon admission. NIHSS scores at the day 30 and 3 month after onset, and infarct volumes on T2 weighted imaging （T2WI） at day 14 after onset were analyzed and compared between each sub-groups. Results The NIHSS scores in the CDM sub-group at both day 30 and the 3 month were significantly lower than the scores in the non-CDM sub-group among the patients having thrombolysis （3.20 _± 2. 40 vs 6. 76 ± 4. 00, t = - 3. 330, P = 0. 002 ; 2. 20 ± 1.70 vs 6.05 ± 4. 06,t =3. 895,P =0. 001 ）, but not among the non-thrombolysis patients （5.22 ± 2. 95 vs 5.66 ± 3.21, t = - 1. 756,P = 0. 084 ; 4. 34 ± 2. 53 vs 5.34 ± 3.42, t = 1. 234, P = 0. 353）. Among the patients having CDM, the thrombolysis group resulted significant lower NIHSS scores at both day 30 and 3 month follow-up than non-thrombolysis group did （ 3.20 ± 2. 40 vs 5.22 ± 2. 95, t = - 2. 210, P = 0. 034 ; 2. 20 ± 1. 70 vs 4. 34 ± 2.53 ,t = - 3. 128 ,P = 0. 003）. However, among the patients of non-CDM, there was no difference in the NIHSS score between the thrombolysis group and the non-thrombolysis group at day 30 and 3 month （6.76±4.00vs5.66±3.21 t=1.209,P=0. 231;6.05±4.06vs5.34±-3.42, t=1.234,P=0.460）. Among the CDM patients, the T2 WI infaret volume in the thrombolysis group was significantly smaller than that in the non-thrombolysis at day 14 onset （ （6. 29 ± 4. 41 ） ml vs （60. 25 ± 49. 23 ） ml, Z = - 4. 848, P = 0. 001 ）. Conclusion CDM may predict the putative penumbra with high specificity and can be applied in the therapy of intra-artery tbrombolytic for acute MCAO patients.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2011年第12期836-840,共5页
Chinese Journal of Neurology
基金
2010年度江苏省卫生厅指导性科研课题资助项目（Z201014）
关键词
磁共振成像
弥散
梗死
大脑中动脉
血栓溶解疗法
Diffusion magnetic resonance imaging
Infarction, middle cerebral artery
Thrombolytic therapy
