脑卒中患者脑脊液乳酸水平与CT及临床的相关性研究

目的　探讨脑卒中患者脑脊液(CSF)乳酸(LA)浓度与CT及临床的关系及其临床意义。方法　以发病3天以内的24例基底节出血患者、9例脑叶出血患者、16例脑梗死患者为观察对象，以21例腔隙性脑梗死患者为对照。采用等速电泳法测定CSFLA浓度。按CT检查结果及多田公式计算出(缺)血量、按Glasgow昏迷观察量表计算入院GCS积分、按改良Edinburh-Scandinavia卒中量表计算入、出院RESSS积分。结果　在基底节出血组，CSFLA浓度明显高于脑梗死组及对照组(P＜0.05或0.01)，入院GCS积分较低，入、出院RESSS积分较高，有的组间差异有统计学意义；CSFLA浓度与血肿量，入院GCS积分及出院RESSS积分间的相关系数为0.455、-0.577、0.547(P＜0.05)；CSFLA浓度≥2.50mmol/L患者的血肿量，入、出院RESSS积分较高，入院GCS积分较低，其中出院RESSS积分间的差异有显著性意义。对脑叶出血、脑梗死患者未发现特殊规律。结论　测定CSFLA浓度对基底节出血患者可作为判断疾病严重程度及预后的指标，对脑叶出血、脑梗死患者的临床意义尚需进一步研究。

Study on the relationshipbetween CSF LA levels and CT scanning or clinical manifestation in the patients with acutecerebral vascular diseases

Objective To explore the relationship between the cerebrospinal fluid(CSF)lactic acid(LA)levels and the CT scanning or the clinical manifestation in the patients with acute cerebral vascular diseases and its clinical meanings.Methods All the patients chosen attacked in no more than 3 days.Among them,there were 24 patients with basal ganglion hemorrhage(BGH),9 patients with cerebral lobar hemorrhage(CLH),and 16 patients with cerebral infarction(CI) as observing cases.21 patients with cerebral lacuna infarction were as control.The CSF LA levels were determined using isotachphoresis.The amount of bleeding or ischemia was counted based on CT scanning and Duo Tian formula.The GCS score at admission and the RESSS scores at admission or discharge were summed up according to the Glasgow Coma Scale or the Revised Edinburh-Scandinavia Stroke Scale,respectively.Results The CSF LA level of BGH group was higher than the ones of cerebral infarction group and control group( P< 0 05 or 0.01).Its GCS score at admission was lower and it RESSS scores at admission and discharge were higher.Some differences were significant statistically.The correlative coefficients between the CSF LA level and the bleeding amount,or the GCS score at admission,or the RESSS score at discharge were 0.445,-0.577 and 0.547( P< 0 05).The bleeding amount and the RESSS score at admission and discharge in the patients whose CSF LA levels were more than 2.50 mmol/L were higher,but their GCS score at admission was lower.The comparison of RESSS score at discharge showed a significant difference.There was no special regularity in CLH group and CI group.Conclusion The determination of CSF LA levels for the patients with BGH can be an index to judge the seriousness and prognosis.The clinical meanings of determine CSF LA in the patients with CLH or CI need the further study. [