寒冷对急性脑梗死病灶周边的作用

目的研究不同气温条件下急性脑梗死病灶周边区的代谢变化。方法应用1.5T磁共振扫描仪对28例临床和MRI确诊为大脑中动脉支配区急性脑梗死的患者行定点分辨选择序列(PRESS)多体素质子磁共振波谱检测半卵圆中心(感兴趣区,ROI)。采用Efilm workstation软件计算出梗死灶外缘距ROI的距离。根据脑梗死发生当天的平均气温和ROI距病灶区8.0 mm以内条件分为0～5℃、5℃～10℃、10℃～15℃及15℃～20℃组,采用SPSS17.0统计软件进行独立样本t检验及单因素方差分析(one-way ANOVA)。结果 0～5℃组N-乙酰天门冬氨酸(NAA)、含胆碱代谢物(Cho)、肌酸/磷酸肌酸(Cr)值均较其他组升高,除Cr值与10℃～15℃组无统计学意义外,其余项目均有显著差异(P<0.05,P<0.01)。5℃～10℃组NAA、Cho、Cr值均较其他组低,除Cho与15℃～20℃组间无显著性差异,其余项目均有显著差异(P<0.05,P<0.01)。虽然10℃～15℃组与平均15～20℃组间差异无显著性(P>0.05),但10℃～15℃组NAA、Cho、Cr值均较15℃～20℃组大。结论平均气温<5℃时,梗死灶周边区损伤随气温降低而减轻;平均气温>10℃时,梗死灶周边的损伤随气温升高而加重;然而,平均气温5℃～10℃组梗死灶周边损伤最为严重。

Effect of cold on peripheral zone of acute cerebral infarction

Objective To explore the metabolic changes around the area of acute cerebral infarction(ACI) under the condition of different temperatures.Methods 28 patients with ACI in the dominated areas of middle cerebral artery,which were diagnosed by clinical and MRI,were examined by the non-invasive technique of the proton magnetic resonance spectroscopy(1H-MRS).The centrum semiovale was examined with 1.5T MR system by selecting point resolved spectroscopy sequence and using multi-voxel approach.The distance of the region of interesting(ROI) from the outer edge of the infarction was measured by Efilm workstation.The subjects were divided into 4 groups according with average ambient temperature of the day at which cerebral infarction attacked,0~5℃,5℃~10℃,10℃~15℃ and 15℃~20℃ groups,respectively.The data were analyzed by independent sample t test and one-way ANOVA with SPSS17.0.Results The values of N-acetylaspartate(NAA),choline(Cho) and creatine(Cr) were the highest in group 0~5℃,there were statistically significant difference to the other 3 groups(P<0.05),except to the level of Cr of group 10℃~15℃.The values of NAA,Cho and Cr in group 5℃~10℃ were the lowest,there were statistically significant difference to the other 3 groups(P<0.05),except to the level of Cho of group 15℃~20℃.Although the values of NAA,Cho and Cr in group 10℃~15℃ were higher than those in group 15~20℃,there were no statistically significant difference between them.Conclusions The degree of damage is alleviated in the area around lesion when the average ambient temperature is between 0 ~ 5℃.The degree of damage is aggravated in the area around lesion when the average ambient temperature is higher than 10℃.However,the degree of damage around the infarction lesion is the most serious between 5℃~10℃.