脑血管储备对缺血性卒中的预测价值

目的探讨脑血管储备的改变是否能预测有颈动脉或者大脑中动脉狭窄或闭塞患者的缺血性卒中的发生。方法采用灌注CT和吸入5％CO2方法测定脑血管储备。研究对象为37例颈内动脉或大脑中动脉狭窄或者闭塞的患者，平均年龄（58．0±11．9）岁。分为两组：储备下降组（脑血管储备〈10％）和储备正常组（脑血管储备≥10％）。所有患者采用药物治疗，通过定期门诊或者电话随访。结果脑血管储备下降组17例，脑血管储备正常组20例。在平均56．9个月的随访中，总共有7例发生缺血性卒中，均发生于脑血管储备下降侧的脑组织，并且都属于脑血管储备下降组（7／17）。缺血性脑卒中的年发生率在脑血管储备下降组和正常组分别是8．7％和0％。Kaplan—Meier生存分析提示脑血管储备下降组发生卒中的风险显著高于正常组（P=0．002，Log-rank法）。结论对于颈内动脉、大脑中动脉狭窄或闭塞的患者，脑血管储备的下降可能预示着未来易于发生缺血性卒中。

The predicting value of cerebrovascular reserve to eschemic stroke in patients with corafid or middle cerebral artery occlusive disease

Objective To explore impaired regional cerebrovascular reserve whether means an increasing risk of future ischemic stroke in patients with coratid or middle cerebral artery occlusive disease, or not. Methods Cerebrovascular reserve was measured with perfusion computerized tomography and inhaling 5% carbon dioxide in 37 patients with carotid or middle cerebral artery stenosis or occlusion. All of the 37 patients come from capital medical university affiliate hospital between March 2006 to July 2009. 27 men and 10 women,from 25 to 76 （58.0 4- 11.9 ） years rid; 17 o~ 37 patients with eerebrovacular reserve less than 10% （ impaired regional cerebrovascular reserve group） ,and 20 of 37 patients with cerebrovascular reserve equal or more than 10% normal rCVR group）. All patients medically treated and follow-uped on out-patient clinic or by telephone. Results During an average follow-up period of 56.9 （24-73）months,total 7 ischemic stroke occurred and all of them were m CVR impaired brain tissue and in the impaired regional cerebrovascular reserve group. The annual risks of ipsilateral stroke in patients with impaired regional cerebrovascular reserve and that with normal regionalcerebrovascular reserve were 8. 7% and 0%, respectively. Kaplan-Meier analysis revealed that the risks of stroke in impaired regional cerebrovascular reserve group was significantly higher than in normal regionalcerebrovascular reserve group （ P = 0. 002,Log-rank test）. Conclusion Impaired regional cerebrovascular reserve may be predictive of subsequent ischemic stroke in patients with internal cerebral artery or middle cerebral artery stenosis or occlusion.