自发性脑出血患者凝血功能与脑血肿及脑水肿的关系

目的探讨自发性脑出血患者出血后体内凝血变化及与脑血肿和脑水肿的关系。方法选择2013年2月～2014年5月保定市满城区人民医院神经内科住院的自发性脑出血患者20例。分别于入院时以及入院第4、8和15天(或出院时)抽取患者静脉血,采用自动校正凝血酶曲线法检测患者凝血功能,其主要参数包括:延迟时间、凝血酶生成潜力、峰值和达峰时间;并行头颅CT平扫检查,应用多田公式计算脑血肿和脑水肿体积,分析其与凝血功能的相关性。结果脑出血患者入院时、入院第4、8、15天凝血酶生成潜力、峰值、达峰时间、脑血肿体积和脑水肿体积比较,差异有统计学意义(P0.01)。Pearson相关性分析显示,延迟时间和达峰时间与脑血肿体积、脑水肿体积呈正相关(r=0.498,P=0.025;r=0.517,P=0.020;r=0.492,P=0.028;r=0.472,P=0.036),凝血酶生成潜力和峰值与脑血肿体积、脑水肿体积呈负相关(r=-0.560,P=0.010;r=-0.480,P=0.032;r=-0.485,P=0.030;r=-0.469,P=0.037)。结论脑出血患者体内凝血功能呈现出动态改变,凝血功能变化与脑血肿体积及脑水肿体积变化相关,凝血功能检测可能是脑出血患者病情预后的重要指标之一。     

凝血酶注射封闭股动脉假性动脉瘤对机体凝血系统的影响

目的:了解超声引导下注射凝血酶(UGTI)治疗医源性股动脉假性动脉瘤(PS)对机体凝血指标的影响,评价超声引导下注射凝血酶治疗PS的可行性.方法:15例经股动脉径路选择性冠状动脉(冠脉)造影和冠脉介入术后医源性股动脉PS患者接受了超声引导下注射凝血酶治疗.男性5例,女性10例,平均年龄(68.5±12.0)岁,选择性冠脉造影1例,经皮冠脉介入14例.单腔的单纯型PS9例,2腔或3腔的复杂型PS6例.分析PS接受凝血酶治疗剂量、治疗结果以及机体凝血指标.注射凝血酶前、注射凝血酶后24小时、注射凝血酶后5～7天测定了以下指标:血小板计数、红细胞压积、血红蛋白、活化的凝血激酶时间、凝血酶原时间、凝血酶时间、纤维蛋白原及二维超声心动图检查.结果:共注射凝血酶21次,平均每次注射凝血酶剂量,单腔为(186±120)IU,双腔或多腔为(388±150)IU.9例单纯型PS患者全部一次成功;6例双腔或多腔的复杂型PS患者4例一次成功,2例复杂型PS患者出现"再通",经重复注射凝血酶后,封闭成功.无一例出现其他部位血栓形成、感染、过敏等并发症.注射凝血酶前后,机体各项凝血指标间相比无显著差异.结论:超声引导下注射凝血酶治疗股动脉PS安全有效,PS瘤腔内局部注射凝血酶对机体凝血系统无明显影响.     

糖尿病患者凝血状态及影响因素研究

目的观察糖尿病患者与非糖尿病患者的凝血状态差异及其影响因素,为临床治疗糖尿病合并凝血功能异常提供参考。方法选择糖尿病患者251例(糖尿病组),糖尿病组又根据是否有大血管病变分为大血管病变组163例,无大血管病变组88例,另选择健康体检者80例(对照组),观察其凝血酶时间(TT)、活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)的差异。结果糖尿病组TT[(16.28±1.44)s vs(17.80±0.97)s]、APTT[(35.57±3.73)s vs(37.46±4.17)s]、PT[(12.60±1.08)s vs(13.84±0.60)s]较对照组明显缩短,Fib[(3.21±0.87)g/L vs(2.91±0.55)g/L]较对照组明显增高(P<0.05,P<0.01)。大血管病变组Fib较无大血管病变组明显升高(P=0.03)。糖尿病组主要影响凝血指标的是糖化血红蛋白、TC、LDL-C。结论糖尿病患者存在凝血系统的异常,糖化血红蛋白、TC、LDL-C水平与凝血指标具有明显的相关性。     

甲磺酸去铁胺对老年脑出血患者血肿及其周围水肿以及功能预后的影响

目的研究甲磺酸去铁胺对老年脑出血患者血肿及其周围水肿以及功能预后的影响。方法将19例脑出血患者随机分为去铁胺组12例和对照组7例,分析2组患者的影像学资料及入院第15、30及90天的改良Rankin量表评分(mRS),将2组资料进行比较。结果与去铁胺组比较,对照组1~8d血肿相对吸收量显著增加,差异有统计学意义(0.15±0.18 vs 0.42±0.23,P=0.013);对照组8~15d血肿相对吸收量显著增加,差异有统计学意义(0.48±0.22 vs 0.74±0.29,P=0.042)。去铁胺组与对照组患者入院第15、30和90天mRS≥3分比例比较,差异无统计学意义(66.7%vs 42.9%,58.3%vs 28.6%,33.3%vs 28.6%,P0.05)。结论甲磺酸去铁胺能够抑制老年脑出血患者血肿的吸收。     

凝血相关指标在急性肺栓塞中的临床意义

目的探讨凝血相关指标在急性肺栓塞(APE)中的临床意义。方法选择该院呼吸科2013~2015年住院的APE患者43例(病例组),并选择同期47名健康体检者作为对照组,采用全自动血凝分析仪对入选者凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、血浆纤维蛋白原(FIB)、凝血酶时间(TT)指标进行检测,观察首次住院及出院前凝血指标变化。结果与对照组相比,病例组PT、APTT显著降低,FIB含量显著升高(P0.05)。病例组治疗后PT、APTT显著升高,FIB含量显著降低(P0.05);但TT在各组中均无明显变化(P0.05)。结论凝血相关指标在急性肺栓塞的临床诊断及溶栓治疗中具有一定的指导意义。     

高血压脑出血患者发病后外周血IgG、IgM、补体C3、补体C4水平的动态变化分析

目的探讨高血压脑出血(HICH)患者发病后外周血免疫球蛋白(IgG、IgM)和补体(C3、C4)水平变化趋势,为免疫支持治疗及判断患者预后提供参考。方法选取2015年1月至2016年1月我院神经外科收治的HICH患者90例为研究对象,按入院时Glasgow昏迷评分分为轻度HICH组(12～15分,30例)、中度HICH组(9～11分,30例)和重度HICH组(3～8分,30例)。选取同期我院收治的未发生脑出血的高血压患者30例作为高血压对照组,选取同期在我院进行健康体检的志愿者30名作为健康对照组。检测比较HICH患者(发病后1～28天)、高血压对照组患者及健康对照组志愿者外周血IgG、IgM、C3、C4水平。结果 HICH患者入院后第1天的外周血IgG、IgM、C3、C4水平显著低于高血压对照组患者和健康对照组志愿者,差异有统计学意义(P0.05)。轻、中、重度HICH三组患者的外周血IgG、IgM、C3、C4水平比较差异有统计学意义(P0.05),三组患者的外周血IgG、IgM、C3、C4水平均随时间的变化而发生变化(P0.05);三组患者的外周血IgG、IgM、C3、C4水平在入院后均逐渐降低,轻度、中度HICH患者在入院后第7天达最低水平,重度HICH患者在入院后第7天或10天达最低水平,随后均逐渐升高,入院后第28天的水平与第1天时的水平相当。结论 HICH发生后患者免疫功能被抑制,发病后第7～10天被抑制的程度最为严重,在此期间宜对患者采取针对性措施,提高其免疫功能,减少感染的发生,改善患者预后。     

疏血通注射液治疗急性脑出血的临床研究

目的观察疏血通注射液对原发性脑出血患者血肿吸收、血肿周围低密度区改变及神经功能恢复情况的影响;同时进行凝血酶-抗凝血酶复合物(TAT)含量的测定,观察疏血通注射液对TAT含量的影响。方法将64例原发性脑出血患者随机分为治疗组(33例)和对照组(31例),治疗组给予疏血通注射液6mL,每日静脉输注1次,连用14d,其他常规治疗同对照组。两组于治疗前、治疗后24h、治疗第7天、治疗第14天行头颅CT检查测量血肿体积、血肿周围低密度区体积,同时采用酶联免疫法(ELISA法)行TAT含量的测定;神经功能改变采用斯堪的那维亚卒中量表(SSS)进行评价。结果治疗后24h两组血肿体积均无明显改变,且两组间无统计学意义;治疗第7天、第14天治疗组与对照组比较血肿体积缩小(P<0.05)。治疗后24h两组血肿周围低密度区体积均增大,且两组间无统计学意义;治疗第7天、第14天治疗组较对照组血肿周围低密度区范围减小(P<0.05),治疗第7天、第14天治疗组较对照组SSS评分明显改善(P<0.05);治疗第14天两组TAT含量均减低,且两组间无统计学意义。结论疏血通注射液能促进急性脑出血时的血肿吸收、血肿周围低密度区缩小和改善神经功能,并可以有效抑制凝血酶的活性。     

脑出血急性期患者血浆去甲肾上腺素、乙酰胆碱的变化及意义

目的：分析脑出血急性期患者血浆去甲肾上腺素（ NE）、乙酰胆碱（ Ach）的变化及临床意义。方法选择45例初发脑出血患者（观察组）和38例健康体检者（对照组）,记录观察组入院第2、10天的平均动脉压、心率、呼吸及血糖水平,入院时及住院第10天完善头颅CT检查,并计算颅内血肿体积;入院第2、10天测定两组血浆NE及Ach水平。结果观察组入院时及入院第10天颅内血肿体积分别为（29．70±4．90）、（22．00±5．05） mL,入院后第2天和第10天平均动脉压、心率、呼吸及血糖水平比较无统计学差异（ P均＞0．05）。观察组第2天、第10天血浆NE水平明显高于对照组（P均＜0．01）;血浆乙酰胆碱水平明显低于对照组（P均＜0．01）;观察组血浆NE、Ach水平第2天与第10天比较无统计学差异（ P均＞0．05）。结论脑出血急性期患者血浆NE水平明显升高、Ach水平明显降低,可能与患者的临床症状有一定联系。     

5-HT、iFABP在重症急性胰腺炎肠功能障碍患者中的水平及临床价值

目的 检测苇症急性胰腺炎(SAP)伴肠功能障碍患者血5-羟色胺(5-HT)及尿液中肠脂肪酸结合蛋白(iFABP)水平,探讨其临床应用价值.方法 ELASA法检测42例SAP伴肠功能障碍患者入院第1天、第3天及第7天血5-HT及尿iFABP的水平,同时记录肠鸣音次数;以20例健康体检人员作为对照组.结果 健康对照组平均肠鸣音次数为(5.6±2.3)次/min.SAP组入院第1天、第3天及第7天肠鸣音次数分别为(2.3±0.7)次/min、(1.7±0.2)次/min与(3.1±1.1)次/min,均较健康对照组显著减少(P值均<0.01).对照组血5-HT含量为(86.7±9.5)ng/ml,SAP组第1天、第3天、第7天含量分别为(112.0±17.8)ng/ml、(130.5±19.7)ng/ml、(107.9±16.3)ng/ml;对照组尿iFABP含量为(90.5±19.8)pg/ml,SAP组分别为(1250.2±425.3)pg/ml、(1586.9±523.4)pg/ml、(1154.6±394.0)pg/ml.SAP组的血5-HT和尿iFABP含量均较对照组显著增加(P值均<0.01);SAP组第3天的含量又较第1天及第7天显著增高,而第1天与第7天之问无显著差异.结论 在SAP早期检测血5-HT及尿iFABP可有效评估患者的肠功能状况,有潜在的临床应用价值.     

凝血功能4项指标检测在临产孕妇中的临床意义

目的：探讨临产孕妇凝血功能4项指标检测在临产孕妇中的临床意义。方法：采用法国STAGO型全自动凝血分析仪,对120例临产孕妇和100例非孕健康妇女进行凝血4项：凝血酶原时间（PT）、活化部分凝血酶时间（APTT）、凝血酶时间（TT）及纤维蛋白原（Fbg）指标的检测,并进行对比和分析。结果：临产孕妇的Fbg明显高于健康对照组,2组差异有统计学意义（P〈0.01）,PT和TT比对照组明显下降,且差异有统计学意义（P〈0.01）。APTT与健康对照组的差异不大,无统计学意义（P〉0.05）。结论：临产孕妇的血液处于高凝状态,在临产前进行凝血功能指标的检测,对预防临产孕妇在分娩过程中及产后可能出现的大出血及弥漫性血管内凝血的发生和诊断有着极其重要意义。     

Pediatric patients with congenital heart disease: thrombin generation measured by calibrated automated thrombography

The aim of this study was to investigate the possible suitability of the calibrated automated thrombography to determine the coagulation status of pediatric patients with congenital heart disease. Thrombin generation was measured in 60 patients with congenital heart disease using the calibrated automated thrombography and compared to data using standard coagulation parameters such as prothrombin, antithrombin, tissue factor pathway inhibitor, prothrombin fragment 1.2 (F 1.2), and activated partial thromboplastin time. A significant positive correlation was observed between prothrombin and the endogenous thrombin potential (P < 0.01; r = 0.295) as well as between prothrombin and peak height (P < 0.01; r = 0.581). A significant negative correlation was seen between tissue factor pathway inhibitor and endogenous thrombin potential (P < 0.01; r = -0.480) and between tissue factor pathway inhibitor and peak height (P < 0.01; r = -0.234). No statistically significant correlation was found between antithrombin and parameters of continuous thrombin generation. Significant correlation was seen neither between activated partial thromboplastin time and F1.2 nor between activated partial thromboplastin time and prothrombin. The data presented here indicate that calibrated automated thrombography measurements determine thrombin generation more accurately and therefore reflect better the coagulation status of pediatric patients with congenital heart disease then standard global coagulation assays such as activated partial thromboplastin time.     

Global tests of haemostasis in critically ill patients with severe sepsis syndrome compared to controls

Haemostatic changes in septic patients are complex, with both procoagulant and anticoagulant changes. Thirty-eight patients with severe sepsis and 32 controls were investigated by coagulation screens, individual factor assays, calibrated automated thrombography (CAT), whole blood low-dose-tissue factor activated (LD-TFA) Rotem and LD-TFA waveform analysis. Thirty-six of 38 patients had an abnormal coagulation screen. The mean levels of factors II, V (P < 0.05), VII, X, XI and XII, antithrombin and protein C (P < 0.01) was decreased in sepsis compared with controls. The mean factor VIII and fibrinogen level (P < 0.001) was increased. CAT in platelet rich and poor plasma showed a prolonged lag time (P < 0.02), decreased peak thrombin (P < 0.02) and delayed time to peak thrombin (P < 0.001) in sepsis patients, however, the endogenous thrombin potential was equivalent in sepsis and controls. In LD-TFA Rotem, septic patients had delayed clot times (P = 0.04) but an increased maximum velocity of clot formation (P < 0.01) and area under the clot elasticity curve (P < 0.01). LD-TFA waveform analysis showed a delayed onset time but an increased rate of clot formation (P < 0.005). In conclusion, global tests of haemostasis suggest that in this patient group, activation of haemostasis is delayed but once initiated thrombin generation and clot formation are normal or enhanced.     

Thrombin generation in haemophilia A patients with mutations causing factor VIII assay discrepancy

Summary. Up to 40% of patients with mild haemophilia A have a discrepancy whereby factor VIII (FVIII) measurements by a two‐stage chromogenic assay (FVIII:C_CH) are disproportionately reduced compared with the FVIII one‐stage clotting value (FVIII:C). Which assay best reflects the coagulation potential and clinical phenotype in this patient group is of clinical significance, yet remains unclear. We have assessed the global coagulant ability of haemophilia patients with FVIII assay discrepancy using calibrated automated thrombography (CAT). A total of 18 patients with mutations Arg531His/Cys or Arg698Trp causing FVIII discrepancy were investigated, together with 12 haemophilia patients with concordant FVIII values and 15 normal controls. Factor VIII levels in all patients and controls were measured using both one‐stage clotting assay and two‐stage chromogenic assay. Thrombin generation was assessed in platelet‐poor plasma by CAT using a low tissue factor concentration (1 pm ). FVIII:C_CH values were below normal in all patients, and in the discrepant group were between 1.5‐ and 8‐fold lower than FVIII:C values. CAT parameters were affected in all haemophilia patients. The endogenous thrombin potential (ETP) was reduced to 58–67% of the mean normal value (1301 nm min^?1), whereas peak thrombin was further reduced to 27–30% of the mean normal value (178 nm ) in both discrepant and concordant patient groups. Analysis of the discrepant patient group showed the most significant correlation between the one‐stage FVIII:C assay and ETP (r² = 0.44) and peak thrombin parameters (r² = 0.27).     

尿中性粒细胞明胶酶相关脂质运载蛋白对脑动脉支架置入术后造影剂肾病严重程度的预测价值

目的评价老年患者尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)对脑动脉支架置入术后致造影剂肾病(CIN)的早期诊断价值及其严重程度的预测价值。方法选择CIN患者15例(CIN组),其中CINⅠ期12例,CINⅡ期3例;非CIN患者15例(对照组),连续收集尿标本进行NGAL分析。结果与对照组比较,CIN组及CINⅠ期、CINⅡ期患者术后3、6、12、24h和CINⅡ期患者术后48h尿NGAL明显增高,CIN组及CINⅠ期、CINⅡ期患者尿NGAL术后0~3h、0~6h、0~12h、0~24h、0~48h绝对变化值明显增高(P<0.05)。与CINⅠ期比较,CINⅡ期患者尿NGAL术后0~6h、0~12h绝对变化值明显增高(P<0.05)。CIN组术后0~6h尿NGAL绝对变化值与术后48h估算肾小球滤过率呈负相关(r=-0.480,P=0.001)。结论动态监测尿NGAL既可早期诊断CIN,也可对CIN严重程度有一定的预测作用。     

Profile of thrombin generation in children with acute lymphoblastic leukemia treated by Berlin-Frankfurt-Münster (BFM) protocols

Treatment with L-asparaginase is associated with coagulation disturbances with deep venous thrombosis being the most common clinical consequence. Use of the calibrated automated thrombogram allows precise estimation of thrombin generated in vitro. We show the first data on thrombin generation, measured by calibrated automated thrombography (CAT), in children with acute lymphoblastic leukemia treated with L-asparaginase. Thrombin generation was measured by means of CAT in 23 children treated for acute lymphoblastic leukemia. Samples were obtained at predefined time points during the induction and reinduction phase of acute lymphoblastic leukemia-intercontinental Berlin-Frankfurt-Münster (BFM) 2000 or Associazione Italiana Ematologica Oncologia Pedaitrica Interim BFM 2000 protocols. Antihrombin and fibrinogen were measured on the same sample. Twenty-eight sets of thrombin generation measurements were collected from 23 patients. We observed no significant effect of antithrombin deficiency and/or hypofibrinogenemia on thrombin generation. Endogenous thrombin generation and peak thrombin were significantly higher during induction than in the reinduction phase (P?相似文献   

Platelet-dependent thrombography: a method for diagnostic laboratories

The thrombin-platelet feedback loop was examined at low concentration tissue factor using calibrated automated thrombography in combination with the elimination of contact factor activation by corn trypsin inhibitor. The results indicated that, when contact factor activation was eliminated, the thrombin-platelet feedback loop was a major determinant of thrombin generating capacity and that platelets had a greater role in regulating the propagation of thrombin generation than its initiation. This method has potential application to the measurement of platelet-dependent thrombin generation in clinical diagnostic laboratories and hence the investigation of patients with apparent hypo- or hypercoagulable phenotypes.     

磁共振血管成像的大脑后动脉偏侧优势对脑梗死预后研究

目的探讨磁共振血管成像(MRA)的大脑后动脉(PCA)偏侧优势对大脑中动脉闭塞患者使用重组组织型纤溶酶原激活剂(rt-PA)的预后价值。方法 53例大脑中动脉分布区梗死的急性缺血性脑卒中患者应用rt-PA静脉溶栓治疗、均在入院时常规进行初期(最初4.5h)MRI检查和定期头颅CT(脑卒中发病后14和21d)检查。将有PCA偏侧优势23例作为优势组,30例无偏侧优势作为无优势组。分析所有患者的临床和影像学数据。结果脑卒中发病后7d,与无优势组比较,优势组患者美国国立卫生研究院卒中量表评分较低[2.8分vs 13.5分,P=0.005],脑梗死面积较小[8.5分vs 6.0分,P=0.007],再灌注成功率高(82.6%vs 60.0%,P=0.001)。存在PCA偏侧优势的患者出现预后良好的校正风险比为8.11(95%CI:1.80⁵0.2,P=0.005)。结论可以将rt-PA静脉溶栓治疗前MRA中存在PCA偏侧优势用作预测大脑中动脉闭塞患者出现良好功能预后的指标。     

凝血异常在HBV相关慢加急性肝衰竭患者血栓形成中的作用

目的观察传统凝血功能和血小板相关指标对HBV相关慢加急性肝衰竭(HBV-ACLF)患者血栓形成事件的作用。方法选取2015年1月—2019年12月在苏州大学附属第一医院住院的HBV-ACLF患者56例,分为发生血栓组(n=24)与未发生血栓组(n=32)。回顾性分析两组患者入院时的一般临床资料,观察入院后第1~7天的凝血功能,血小板计数和血小板功能相关指标平均血小板体积(MPV)的变化。符合正态分布的计量资料两组间比较采用t检验,不符合正态分布的计量资料两组间比较采用Mann-Whitney U秩和检验;计数资料两组间比较采用χ2检验。采用重复测量资料方差分析比较组内及组间不同时间凝血指标的差异。结果HBV-ACLF患者在入院时,发生血栓组年龄31.5(29.0~34.0)岁,较未发生血栓组年龄48.5(36.0~50.7)岁小,差异有统计学意义(Z=-2.637,P=0.008);在入院当天,MPV在发生血栓组与未发生血栓组间差异无统计学意义(P>0.05)。在入院后第2~7天,MPV值发生血栓组与未发生血栓组间差异均有统计学意义(t值分别为-2.696、-2.742、-2.894、-4.174、-3.945、-4.716,P值均<0.01)。发生血栓组MPV的峰值为入院第5天,均值为(13.90±1.12)fl,高于正常值范围。所有纳入患者在入院时,PT均值为(28.8±7.2)s、APTT均值(50.5±8.7)s、INR均值(2.6±0.7),均高于正常值;Fb均值为(1.16±0.3)g/L、血小板计数均值为(107.7±26.5)×109/L,均低于正常值。而PT、APTT、Fbg、INR及血小板计数在发生血栓组与未发生血栓组间差异均无统计学意义(P值均>0.05)。结论肝衰竭患者凝血功能障碍,更多是一种低平衡状态,是复杂与异质性的,需要个体化处理。HBV-ACLF患者中,易发生血栓事件者可能与血小板的功能有关,而与血小板计数及凝血常规指标关系不大。     

直接和补救性经皮冠状动脉腔内成形术患者血浆丙二醛水平的动态变化及其意义

目的观察直接PTCA和补救性PTCA再灌注过程中血浆丙二醛（malondialdehyde,MDA）的动态变化,并分析其变化的机制和意义。方法对直接PTCA和补救性PTCA成功的40例急性心肌梗死（AMI）患者为研究对象,动态观察入院即刻及血管开通后1、4、8、24、48h和第7天血浆MDA的变化规律。结果(1)AMI患者入院即刻血浆MDA明显高于正常值（P＜0.001）,血管开通后1h达到峰值,而后逐渐下降,到第7天时仍高于入院时水平。再灌注越早,MDA水平越低。(2)心梗后心功能KillipⅡ-Ⅳ级组峰值明显高于Ⅰ级组（P＜0.001）,且出院前射血分数与再灌注后1hMDA水平呈负性相关（P＜0.001）。结论AMI患者行直接PTCA和补救性PTCA后血浆MDA水平明显升高,再灌注后1h达到高峰;延迟再灌注和心梗后心功能恶化可使MDA水平进一步升高。     

脑桥梗死锥体束继发Wallerian变性的磁共振扩散张量成像研究

目的应用磁共振扩散张量成像(DTI)研究脑桥梗死后锥体束继发Wallerian变性的演变过程与神经功能恢复的关系。方法对16例脑桥梗死患者(病例组)于发病<7 d、15 d、30 d、90 d和180 d进行DTI检查。另选16例正常志愿者作为对照组。测量梗死区下方的延髓、上方的大脑脚、内囊后肢及中央前后回皮质的各向异性分数(FA)值,比较病例组各时间点梗死侧与对侧以及对照组各部位FA值的差异,计算FA比值(rFA),并进行临床神经功能评分分析。结果与对照组比较,病例组脑桥梗死灶同侧的延髓、大脑脚、内囊后肢以及中央前后回皮质FA值均有不同程度降低,这种降低的趋势在发病15 d时最为显著,180 d基本恢复正常。患者发病15d时的rFA与90d、180d时的Fugl-Meyer运动功能评分均呈正相关。结论 DTI能够早期检测脑桥梗死后锥体束纤维继发的Wallerian变性。发病早期病灶同侧锥体束FA值下降的程度可预示患者远期运动功能恢复的程度。