不同形态腔隙性脑梗死与预后的关系

目的分析穿支动脉病变引起的腔隙性脑梗死形态与其预后的关系。方法收集2011年6月至2013年9月广西脑卒中中心通过磁共振弥散加权成像(diffusion weighted imaging,DWI)确诊的急性腔隙性脑梗死患者,并根据DWI特征,把急性腔隙性脑梗死的梗死形态分为椭圆形和串珠形。对两种形态脑梗死患者的人口形态特征、危险因素、入院和出院时的NIH卒中评分以及出院3个月后Ranking评分进行评估,同时分析其卒中机制。结果共纳入189例患者,其中串珠状脑梗死69例(36.5%),而椭圆形脑梗死120例(63.5%)。两组患者的基线无差别。然而串珠形梗死组最大梗死直径较椭圆形组大(13.8±2.3 mm vs.10.6±3.2 mm,P=0.006)。早期神经功能恶化同样在串珠形脑梗死组较椭圆形组更常见(24.6%vs.5.0%,P=0.009)。早期神经功能恢复在串珠形脑梗死患者更差(30.5%vs.10.8%,P=0.018)。多元Logistic回归分析显示:串珠形脑梗死病灶与早期神经功能恶化有关(OR=7.55,95%CI:1.73~33.25,P=0.010),而与早期神经功能恢复不良有关(OR=5.75,95%CI:1.53~28.70,P=0.030)。结论在穿支病变引起的腔隙性脑梗死中,串珠状脑梗死与早期神经功能恶化及早期神经功能恢复不良显著相关。     

孤立性脑桥梗死急性期神经功能缺损进展的预测因素

目的探讨孤立性脑桥梗死急性期神经功能缺损进展的预测因素。方法收集发病48 h内经DWI证实的138例孤立性脑桥梗死患者的临床资料,据卒中发生后病情最严重时NIHSS评分变化(NIHSS评分较入院增加≥2分或运动障碍评分增加≥1分)分为急性期神经功能缺损进展组(进展组)和非进展组。比较两组的危险因素、实验室检查及影像学检查特征,采用Logistics回归分析急性期神经功能缺损进展的预测因素。结果单因素分析显示,进展组空腹血糖、入院时NIHSS评分、出院时的mRS评分明显高于非进展组(P0.05)。进展组累及脑桥腹侧表面梗死、梗死灶最大直径、重度脑室旁WMH及皮质下WMH明显高于非进展组(P0.05)。Logistic回归分析显示累及脑桥腹侧表面梗死(OR=0.160,95%CI:0.052~0.493,P=0.001)、重度脑室旁WMH(OR=2.824,95%CI:1.206~6.614,P=0.017)及重度皮质下WMH(OR=3.460,95%CI:1.427~8.393,P=0.006)是孤立性脑桥梗死急性期神经功能缺损进展的独立危险因素。结论累及脑桥腹侧表面梗死及重度WMH是孤立性脑桥梗死急性期神经功能缺损进展的预测因素。     

急性脑干梗死患者预后不良的预测因子

目的探讨急性脑干梗死患者预后不良的预测因子。方法收集并记录133例急性脑干梗死患者的临床资料。根据患者发病30 d时改良的Rankin量表(mRS)评分及是否死亡判断预后。采用多因素Logistic回归分析法分析急性脑干梗死患者预后不良的预测因子。结果本组患者发病30 d时预后不良31例(23.3%),其中死亡5例,严重残障26例。与预后良好患者比较,预后不良患者入院时有意识障碍和脑部多发梗死灶的比例以及美国国立卫生研究院卒中量表(NIHSS)评分明显增高(均P0.05)。多因素Logistic回归分析显示:脑部多发梗死灶(OR=6.819,95%CI:1.615~28.797,P0.01)和入院时NIHSS评分(OR=1.242,95%CI:1.068~1.443,P0.01)是急性脑干梗死患者预后不良的独立预测因子。结论脑部多发梗死灶和入院时NIHSS评分是急性脑干梗死患者预后不良的独立预测因子。     

心房颤动与急性缺血性卒中静脉溶栓致出血转化的相关性及危险因素分析

目的探讨心房颤动与急性缺血性卒中重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓致出血转化的相关性,分析房颤患者溶栓后出血转化的危险因素。方法回顾性分析接受rt-PA静脉溶栓治疗的147例急性缺血性卒中患者,将入选病例分为非房颤组与房颤组,比较两组患者溶栓后出血转化(HT)的差异,采用单因素和logistic回归分析房颤患者溶栓后出血转化的危险因素。结果 147例入组患者中房颤患者66例,非房颤患者81例,房颤组HT与非房颤组比较差异有统计学意义[27.27%(18/66)与14.81%(12/81),χ2=3.071,P=0.028],房颤组症状性HT与非房颤组比较差异亦有统计学意义[12.12%(8/66)与3.70%(3/81),χ2=3.798,P=0.015],logistic回归分析表明伴发房颤的患者基线收缩压高(OR=11.285,95%CI 1.576-68.377,P=0.035)、基线NIHSS评分较高(OR=2.608,95%CI 1.072-4.380,P=0.013)、早期头部CT有缺血改变(OR=1.595,95%CI 1.164-3.258,P=0.023)、起病-溶栓时间(OTT)较长(OR=93.114,95%CI 7.385-177.972,P=0.006)、溶栓24h内血压变异性大(收缩压变异性OR=18.638,95%CI 1.433-65.634,P=0.004;舒张压变异性OR=21.449,95%CI 1.528-56.420,P=0.003)与溶栓后发生HT显著相关。结论房颤与静脉溶栓后HT具有相关性。基线收缩压高、基线NIHSS评分较高、早期头部CT有缺血改变、OTT较长、溶栓24h内血压变异性大是房颤患者静脉溶栓后发生HT的危险因素。     

非心源性脑梗死患者急性期血压变异与早期神经功能恶化的相关性研究

目的探讨非心源性脑梗死患者急性期24 h血压变异和早期神经功能恶化的关系。方法采用病例对照研究方法连续登记急性非心源性脑梗死患者,收集一般临床资料,连续血压监测并计算24 h血压变异的各参数,按照入院7 d内有无发生脑梗死早期神经功能恶化进行分组比较,建立Logistic回归模型分析24 h血压和血压变异参数与早期神经功能恶化的关系。结果 221例入组患者中59例(26.7%)出现早期神经功能恶化。出现早期神经功能恶化组24 h平均收缩压和收缩压变异系数显著高于未发生组[(145.8±18.2)mm Hg vs.(139.9±20.3)mm Hg;9.0(7.3~11.2)vs.8.4(6.9~10.2)],差异均有统计学意义(P0.05)。多因素校正后,24 h平均收缩压水平和收缩压变异系数增大是发生早期神经功能恶化的独立危险因素(每10 mm Hg 24 h平均收缩压OR=1.285,95%CI(1.059~1.559);收缩压变异系数OR=1.206,95%CI(1.050~1.384))。结论入院后24 h收缩压变异增大是急性非心源性脑梗死7 d内发生早期神经功能恶化的危险因素。     

大脑中动脉闭塞致急性脑梗死患者早期神经功能恶化的影响因素分析

目的分析大脑中动脉(MCA)闭塞致急性脑梗死患者早期神经功能恶化的影响因素。方法连续回顾性纳入2017年1月-2019年12月我院神经内科MCA闭塞致急性脑梗死患者134例,入院72 h内美国国立卫生研究院卒中量表(NIHSS)评分较入院基线NIHSS评分增加≥2分为早期神经功能恶化(early neurological deterioration,END),共有48例(简称END组),非早期神经恶化86例(简称非END组),单因素分析两组患者入院时一般资料,将有意义的指标(P 0.05)纳入Logistic模型,通过多因素Logistic回归分析评估单侧MCA闭塞致急性脑梗死患者发生END的影响因素。结果 (1)与非END组相比,END组患者性别、年龄、发病时间、入院NIHSS评分、侧支循环,以及血压变异性(blood pressure variability,BPV)参数SBPsd、SBPcv、SBPmax-min、DBPsd、DBPcv、DBPmai-min等差异均有统计学意义(P 0.05)。(2)多因素Logistic回归分析提示:侧支循环不良(OR=8.330,95%CI1.629～42.587,P=0.011)、BPV参数SBPmax-min(OR=1.110,95%CI 1.008～1.221,P=0.033)是MCA闭塞致急性脑梗死患者发生END的独立危险因素,BPV参数SBPmax-min的ROC曲线下面积(AUC)为0.85(95%CI 0.788～0.912,P 0.001),预测END的敏感度93.8%,特异度64%,最佳截断值35.5。结论影响MCA闭塞致急性脑梗死患者END的因素较多,其中侧支循环不良、血压变异性(BPV)是END的独立危险因素。     

急性缺血性脑卒中患者静脉溶栓后早期神经功能恶化的研究

目的探讨发病6 h内静脉溶栓的急性缺血性脑卒中患者发生早期神经功能恶化(END)的危险因素。方法回顾性分析2017年7月至2019年8月该科收治的151例发病6 h内进行静脉溶栓的急性缺血性脑卒中患者的临床资料,以溶栓后24 h内美国国立卫生研究院卒中量表(NIHSS)较前增加≥4分作为END标准将患者分为恶化组与非恶化组,应用多因素logistic回归分析溶栓后END的危险因素。结果 151例患者中恶化组26例,非恶化组125例。恶化组患者的年龄、NIHSS评分、房颤患病率高于非恶化组(P 0.05);发病到静脉溶栓时间(OTT)低于非恶化组(P 0.05);两组患者的TOAST分型比较,差异具有统计学意义(P 0.05)。logistic回归分析结果显示,NIHSS评分(OR=1.124,95%CI=1.007～1.254)、房颤(OR=6.425,95%CI=1.230～33.561)、收缩压(OR=1.031,95%CI=1.001～1.063)、冠心病(OR=0.072,95%CI=0.006～0.904)与溶栓后END显著相关(P 0.05)。结论高NIHSS评分、房颤及高收缩压患者静脉溶栓后发生END风险大。     

孤立性脑桥梗死预后不良的影响因素分析

目的探讨急性孤立性脑桥梗死预后不良的影响因素。方法采用头颅MRI检查测定73例急性孤立性脑桥梗死患者的梗死灶最大直径、动脉供血分布及穿支动脉粥样硬化情况。采用头颅MRA或CTA评价颅内血管狭窄程度。应用颈动脉彩超评价颅外动脉粥样硬化情况。根据出院mRS评分将患者分为预后不良组(mRS评分≥3分)和预后良好组(mRS评分3分)。结果与预后良好组比较,预后不良组糖尿病发生率、入院及出院NIHSS评分、早期进展率、空腹血糖水平显著增高,男性比率显著降低(P 0. 05～0. 01)。与预后良好组比较,预后不良组脑桥多发供血区梗死、穿支动脉粥样硬化、椎基底动脉狭窄比率及梗死灶最大径显著升高(均P 0. 01)。穿支动脉粥样硬化及基底动脉狭窄是脑桥梗死预后不良的相关危险因素(OR=22. 137,95%CI:2. 563～191. 228,P=0. 005; OR=28. 552,95%CI:2. 347～347. 313,P=0. 009)。结论穿支动脉粥样硬化及基底动脉狭窄是急性孤立性脑桥梗死预后不良的相关危险因素。     

缺血性卒中伴发癫(癎)的危险因素分析

目的 探讨缺血性卒中伴发癫(癎)的危险因素,以加强早期预防并改善预后.方法 根据斯堪地那维亚卒中评分(SSS)对101例发病<24 h的缺血性卒中伴发癫(癎)患者进行神经功能缺损程度评价,同时记录患者性别,年龄,既往史(高血压、冠心病、心房纤颤、2型糖尿病、高脂血症),电解质(血清钾、钠、氯),发病状态(安静、活动),缺血性卒中亚型(动脉粥样硬化性血栓性脑梗死、脑栓塞、腔隙性梗死),脑梗死后渗血,病灶部位(脑叶、基底节区),受累大脑半球侧别(左侧、右侧、双侧),脑萎缩及脑白质脱髓鞘病变等临床资料,分别进行单因素分析和多因素非条件Logistic回归分析.结果 单因素分析显示,与单纯缺血性卒中患者相比,缺血性卒中伴发癫(癎)者缺血性卒中亚型(脑栓塞)、脑梗死后渗血、病灶部位(脑叶,其中额叶所占比例达48.72%)、受累大脑半球侧别(右侧),以及神经功能缺损程度(SSS评分<30分)均存在明显差异(均P≤0.05);而性别、年龄、既往史、电解质指标、发病时状态、脑萎缩程度、脑白质脱髓鞘病变等因素,两组差异无统计学意义(均P>0.05).多因素非条件Logistic回归分析表明,脑栓塞(OR=0.152,95%CI:0.065～0.496;P=0.011)、脑梗死后渗血(OR=0.105,95%CI:0.020～0.549;P=0.008)、脑叶皮质受累(OR=0.099,95%CI:0.044～0.225;P=0.000)、SSS评分<30分(OR=0.145,95% CI:0.062～0.337;P=0.000)等因素为缺血性卒中伴发癫(癎)的主要危险因素,而右侧大脑半球受累(OR=0.638,95%CI:0.311～1.308;P=0.220)则不增加缺血性卒中伴发癫(癎)的风险.结论 具有脑栓塞、脑梗死后渗血、病灶位于脑叶(特别是额叶)、SSS评分<30分等因素的缺血性卒中患者易伴发癫(癎).     

基于CT灌注成像评估侧支循环在急性缺血性脑卒中取栓前后脑梗死进展及预后评估中的应用

目的探讨基于CT灌注成像(CTP)评估的侧支循环对急性前循环大动脉闭塞患者取栓前后脑梗死进展及临床预后的影响。方法回顾性分析浙江省人民医院神经内科自2018年5月至2019年9月收治的110例发病24 h以内的急性前循大动脉闭塞患者的资料。所有患者均完成取栓手术,采用区域性软脑膜侧支(rLMC)评分对四维CT血管造影(4D-CTA)上的全时相融合像(tMIP)进行侧支循环评估;根据CTP的核心脑梗死体积和术后1周内头颅MR的DWI影像结果,计算进展梗死体积;采用改良Rankin量表(mRS)评分评估患者术后3个月时预后情况。结果(1)侧支循环好组患者56例,侧支循环差组患者54例。年龄(OR=0.951,95%CI:0.910~0.993,P=0.023)、心功能不全(OR=0.116,95%CI:0.018~0.731,P=0.022)、基线空腹血糖(OR=0.788,95%CI:0.646~0.961,P=0.019)、觉醒性卒中(OR=0.093,95%CI:0.023~0.380,P=0.001)及颈内动脉段闭塞(OR=7.604,95%CI:2.650~21.821,P=0.000)是侧支循环的独立影响因素。(2)侧支循环评分(95%CI:-2.947~-1.474,P=0.000)、缺血半暗带体积(95%CI:0.065~0.126,P=0.000)、脑组织水肿评分(95%CI:2.952~7.600,P=0.000)、出血转化(95%CI:8.966~23.114,P=0.000)及24 h美国国立卫生研究院卒中量表(NIHSS)评分(95%CI:0.606~1.248,P=0.000)是进展梗死体积的独立影响因素。(3)预后良好组患者共59例,预后不良组患者共51例。出血转化(OR=0.019,95%CI:0.001~0.275,P=0.004)及进展梗死体积(OR=0.824,95%CI:0.756~0.897,P=0.000)是急性前循环大动脉闭塞取栓患者远期预后的独立影响因素。结论基于4D-CTA的rLMC侧支循环评分对发病24 h内急性前循环大动脉闭塞取栓患者的进展梗死体积有良好的预测作用,并可通过进展梗死体积进一步预测患者预后。     

脑梗死患者脑血管反应性研究

目的应用经颅多普勒超声结合屏气试验评价脑梗死患者的脑血管反应性（CVR）。方法采用经颅多普勒超声结合屏气试验检测30例急性期颈内动脉系统脑梗死患者,30例急性期腔隙性脑梗死患者的屏气指数（BHI）,并与60例健康者进行对比。结果急性期颈内动脉系统脑梗死患者和腔隙性脑梗死患者屏气指数均显著低于对照组,颈内动脉系统脑梗死侧显著低于对侧和腔隙性脑梗死患者。结论脑血管反应性与脑梗死有密切关系,检测脑血管反应性对于预测脑卒中风险至关重要。     

Regional cerebral blood flow, diaschisis, and steal after stroke

Regional CBF was measured by 133Xe inhalation in unilateral cerebral infarction, carotid TIAs, and normal volunteers. Regional CBF values were bilaterally and symmetrically reduced in patients measured within 3 weeks after stroke. Later, rCBF values returned toward normal in the contralateral hemisphere of patients with infarction and in both hemispheres with carotid TIAs. In cases with carotid occlusive disease, flow reduction was seen in the contralateral posterior cerebral artery distribution, with hyperemia in ipsilateral occipital lobe caused by interhemispheric steal. Brainstem-cerebellar flow values were increased following acute cerebral infarction if patients were alert but reduced if consciousness was impaired.     

伴房颤的急性脑梗死患者梗死灶分布特点及相关因素分析

目的研究伴房颤的急性脑梗死患者梗死灶分布特点,并对患者的相关临床资料进行分析。方法回顾性分析78例伴房颤的急性脑梗死患者和123例单纯急性脑梗死患者临床和影像学资料,比较两组间性别构成、年龄、既往史、美国国立卫生研究院神经功能缺损评分(NIHSS)、脑梗死灶分布等差异。结果与单纯急性脑梗死患者比较,伴房颤的急性脑梗死患者入院NIHSS评分、年龄以及合并糖尿病、冠心病病史比例较高,梗死部位以累及前循环、右半球最为多见(均P0.05),而在性别构成以及合并高血压、血脂异常比例方面无统计学差异(均P0.05)。结论伴房颤的急性脑梗死患者较单纯急性脑梗死患者病情重,病灶多位于前循环和右半球,其发病与年龄以及合并糖尿病、冠心病病史密切相关。     

Contralateral Cerebral Infarction after Stent Placement in Carotid Artery: An Unexpected Complication

Stenting is a useful alternative treatment modality in carotid artery stenosis patients who are too high-risk to undergo carotid endarterectomy (CEA). We report a case of contralateral cerebral infarction after stenting for extracranial carotid stenosis. A 78-year-old woman was admitted to the hospital with left-sided weakness. Based on magnetic resonance imaging (MRI) of the brain and conventional angiography, she was diagnosed with an acute watershed infarct of the right hemisphere secondary to severe carotid stenosis. Stenting was performed for treatment of the right carotid artery stenosis after a one-week cerebral angiogram was completed. Thirty minutes after stent placement, the patient exhibited a generalized seizure. Four hours later, brain MRI revealed left hemispheric cerebral infarction. Complex aorta-like arch elongation, tortuosity, calcification, and acute angulation at the origin of the supra-aortic arteries may increase the risk of procedural complications. In our case, we suggest that difficult carotid artery catheterization, with aggressive maneuvering during stenting, likely injured the tortuous, atherosclerotic aortic arch, and led to infarction of the contralateral cerebral hemisphere by thromboemboli formed on the wall of the atherosclerotic aorta.     

Regional Cerebral Blood Flow,Diaschisis, and Steal After Stroke

Regional CBF was measured by ¹³³Xe inhalation in unilateral cerebral infarction, carotid TIAs, and normal volunteers. Regional CBF values were bilaterally and symmetrically reduced in patients measured within 3 weeks after stroke. Later, rCBF values returned toward normal in the contralateral hemisphere of patients with infarction and in both hemispheres with carotid TIAs. In cases with carotid occlusive disease, flow reduction was seen in the contralateral posterior cerebral artery distribution, with hyperemia in ipsilateral occipital lobe caused by interhemispheric steal. Brainstem-cerebellar flow values were increased following acute cerebral infarction if patients were alert but reduced if consciousness was impaired.     

急性脑梗死缺血半暗带演变的磁共振成像研究

目的：探讨应用磁共振弥散／灌注成像技术判断急性脑梗死后缺血半暗带IP存在的范围和时间规律。方法：对72例发病时间在1～24h的急性脑梗死患者行常规MRI、磁共振弥散加权成像（DWI）和磁共振灌注加权成像（PWI）确定IP的范围，计算梗死中心区、IP区及对侧镜像区的ADC值和rADC值并加以比较。结果：26例发病时间〈6h的患者PWI显示存在低灌注区者，其中PWI〉DWI者21例，30例发病时间在6～24h的患者PWI显示存在低灌注区者，其中PWI〉DWI者2例；PWI〉DWI者病灶中心ADC值与IP区及对侧镜像区ADC值差异有统计学意义，其IP区ADC值与其对侧镜像区差异无统计学意义。结论：DWI和PWI结合能灵敏的判断IP的存在，IP存在的时间窗有一定的个体差异。     

急性脑梗死患者图片命名脑磁图特征研究

目的:研究急性脑梗死患者在图片命名任务中脑磁图(MEG)的特征。方法:对13例单侧急性脑梗死表现出运动性失语症状的患者于发病后1～2周进行图片命名测试,同时用MEG记录了在此过程中大脑皮层相应功能区产生反应的潜伏期和磁场强度。结果:在图片命名任务中,有以下脑区域被激活:双侧枕叶、双侧颞枕叶交界区、优势半球Wernicke区、优势半球Broca区等脑区域。患者组出现:(1)优势半球Wernicke区反应ECD强度nAm与对照组nAm相比明显降低(P<0.05);(2)优势半球Broca区反应ECD强度降低;而潜伏期与对照组ms相比明显延迟。结论:MEG可灵敏的检测出急性脑梗死患者由于语言形成中枢相关皮质区域神经元及皮质下纤维的损伤而导致的优势半球Wernicke区和Broca区反应潜伏期和ECD强度发生的改变,并能客观的评价该中枢功能的损伤程度。     

Correlation between regional cerebral blood flow and EEG frequency in the contralateral hemisphere in acute cerebral infarction.

The relationship between the rCBF and the electroencephalographic (EEG) frequency was investigated in the contralateral hemisphere of 22 patients with acute cerebral infarction. Reduced rCBF was observed in all patients studied. The degree of rCBF reduction was mild, moderate, or severe and ranged between 6 and 80% from the lowest age-matched normal values obtained in our laboratory. The frequency indices remained within normal limits (mean - 10.4 Hz) in 16 patients. Slower frequencies (mean - 6.3 Hz) were recorded in 6 patients. No correlation was found between the two parameters (P = 0.89). Both the EEG frequency and the rCBF are known to be closely related to the cerebral metabolic rate. The observed rCBF depression without concomitant changes in the EEG frequency raises the question of the role of globally-reduced cerebral metabolism as the cause of rCBF reduction in the noninfarcted hemisphere in stroke patients. Our findings constitute additional evidence that the contralateral hemisphere is involved in the haemodynamic changes occurring in acute cerebral infarction.     

Window narrowing: a new method for standardized assessment of the tissue at risk-maximum of infarction in CT based brain perfusion maps

BACKGROUND: Mapping of brain perfusion using bolus tracking methods is increasingly used to assess the amount and severity of cerebral ischemia in acute stroke. Using relative perfusion maps, however, it is difficult to identify the tissue at risk-maximum (TARM) of infarction with sufficient reliability and reproducibility. METHODS: We analysed 76 perfusion computed tomography (PCT) derived maps of cerebral blood flow (CBF), cerebral blood volume (CBV) and time-to-peak (TTP) in 40 acute stroke patients using multidetector row technology and standard software (Somatom VolumeZoom, Siemens, Germany). 'Window narrowing' of the color maps was performed until color homogenisation of the contralateral unaffected hemisphere was reached. Tissue still depictable on the affected hemisphere after sufficient window narrowing was defined as the TARM. We analysed presence and size of the TARM on PCT maps, its relative perfusion values by comparison with contralateral, mirrored tissue, and its correlation with occurrence and final size of cerebral infarction on follow-up imaging. RESULTS: An ischemic area was visible in 64, 58.9 and 72.6% on the conventional CBF, CBV and TTP maps, respectively. After window narrowing, a TARM was present in 56.8, 54.1 and 63.0% of slices comprising 11.9, 11.6 and 21.1% of the ipsilateral hemisphere (CBF, CBV and TTP), respectively. The relative perfusion values were 38.7 (CBF) and 43.0% (CBV) for the entire ischemic area and 11.3 (CBF) and 13.3% (CBV) for the TARM. Definite cerebral infarction was visible on 68.1% of the target slices comprising 23.7 +/- 22.9% of the ipsilateral hemisphere. The size of the TARM correlated slightly better with the final infarction size (r=0.74-0.82) than the entire ischemic area (r=0.61-0.79). With respect to the occurrence of cerebral infarction, the presence of a TARM on CBF maps showed the best positive (97.9%) and negative (72.7%) predictability. DISCUSSION: On PCT maps, window narrowing provides a standardized display of the TARM in peracute stroke. The severely reduced values of relative CBF and CBV suggest the TARM to indicate tissue most prone to infarction.     

糖化血红蛋白与急性脑梗死发病关系的临床研究

目的 探讨急性脑梗死患者与正常对照组糖化血红蛋白(HbA1c)含量的差异,脑梗死患者HbA1c含量与其神经功能缺损程度评分的相关性以及影像学中脑梗死病灶数与HbA1c含量间的关系.方法 选取186例发病1周内的急性脑梗死患者,入院后行神经功能缺损程度评分,人院24 h内空腹查FibAlc,发病或病情稳定48 h后查颅脑MRI,脑梗死恢复期行葡萄糖耐量检查.同时对160名健康体检者抽空腹血查HbA1c、行葡萄糖耐量实验.观察脑梗死患者与健康体检者HbA1c水平的差异.脑梗死患者HbA1c含量与其神经功能缺损程度评分的相关性以及HbA1c含量与脑梗死病灶个数的关系.结果急性脑梗死患者HbA1c水平(6.982%±1.803%)较对照组(5.128%±0.592%)增高,比较差异有统计学意义(P<0.05);脑梗死患者血中HbA1c含量与其神经功能缺损程度评分呈正相关(r=0.760,P<0.05);2个脑梗死病灶组HbA1c含量(6.635%±0.427%)与1个病灶组(5.803%±0_307%)比较差异有统计学意义(P<0.05),3个及3个以上病灶组HbA1c含量(8.571%±0.519%)分别与1个病灶组、2个病灶组比较差异有统计学意义(P<0.05).结论 糖尿病是脑梗死的重要危险因素,较高水平的HbA1c引起的一系列脑血管病理改变是脑梗死事件发生的重要冈素.HbA1c水平也是早期对病情严重程度评估的一个重要指标,积极控制高血糖、降低HbA1c水平有助于减少脑梗死事件的发生.