磁共振灌注成像－弥散成像不匹配对指导超时间窗急性缺血性卒中患者溶栓的价值

目的 探讨磁共振灌注成像－弥散成像（perfusion weighted imaging-diffusion weighted imaging，PWI-DWI）不匹配对指导超时间窗（>6h）的急性缺血性卒中患者溶栓的价值。方法 选择在发病12h内完成磁共振检查，且（PWI-DWI）/DWI×100%>30%的40例急性缺血性卒中患者，分为溶栓组和对照组，溶栓组给予重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator，rt-PA）0.6～0.9mg/kg静脉溶栓治疗，对照组常规治疗。两组患者在溶栓前、溶栓后1周、2周、3个月分别行美国国立卫生院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分，溶栓前、溶栓后2周、3个月分别行日常生活能力量表（activities of daily living，ADL）评分。结果 溶栓组在溶栓后1周、2周、3个月NIHSS评分均较对照组降低（P<0.01）；在2周和3个月，溶栓组ADL评分较对照组明显升高（P<0.01）。结论 在PWI>DWI影像学模式指导下，适当延长急性缺血性卒中的溶栓时间窗具有可行性。

The Value of PWI-DWI Mismatch to Guide Thrombolytic Therapy with Broadened Therapeutic Window for Cerebral Infarction

Objective To explore the value of magnetic resonance perfusion-weighted imaging（PWI） -diffusion-weighted imaging（DWI） mismatch to guide thrombolytic therapy beyond the time window（〉6h） in patients with acute cerebral infarcts.
Methods 40 patients with acute cerebral infarcts which were imaged by magnetic resonance and（PWI-DWI）/DWI×100%〉30% within 12 hours after symptom onset were divided into thromobolytic group and control group. The patients in thromobolytic group were treated with intravenous rt-PA（0.6-0.9mg/kg）, the controls were received common therapy. The two groups were scored with National Institutes of Health Stroke Scale（NIHSS）/Activities of Daily Living（ADL） score respectively at pre-thrombolysis, 1W, 2W and 3M after thrombolysis.
Results The NIHSS score of the thromobolytic group at 1W, 2W and 3M after thrombolysis is lower than that of the control group（P〈0.01）, the ADL score of the thromobolytic group at 2W and 3M after thrombolysis is higher than that of the control group significantly（P〈0.01）.
Conclusion Guided by PWI〉DWI image, extending the time window for thrombolytic treatment of acute ischemic stroke is beneficial and feasible.