急性缺血性卒中患者谷氨酸的释放研究

目的谷氨酸释放所致神经元兴奋毒性损伤在局灶性脑缺血的发病展性缺血性卒中患者谷氨酸升高的时间和谷氨酸释放抑制剂及谷氨酸受体拮抗剂的治疗时间窗.方法本研究共纳入128例脑梗死病人.用高效液相色谱分析(HPLC)检测了病人和对照者的血浆和脑脊液(CSF)谷氨酸浓度,并同时评定了加拿大卒中标准(CSS)积分和脑梗死容积(CTV).结果病人的平均血浆和CSF谷氨酸浓度均显著高于对照组(P分别小于0.01和0.001).50例进展性卒中患者的平均血浆和CSF谷氨酸浓度均显著高于78例稳定性卒中组.CTV≥10cm3的卒中患者的CSF谷氨酸浓度显著高于CTV＜10 cm3患者,并且50例进展性卒中患者的CSF谷氨酸浓度与其CTV值显著相关(r=0.303,P＜0.05).结论本结果提示,急性脑缺血患者预防神经病学进展,谷氨酸拮抗剂的应用有较宽的治疗时间窗.CSF中的谷氨酸含量可作为判断缺血性卒中的进展和谷氨酸释放抑制剂的一个指标.

Glutamate release in patients with acute ischaemic stroke

Objective To investigate the duration of glutamate increase in patients with stable and progressing ischaemicstroke and determine the time window for treatment with inhibitors of glutamate release or glutamate receptor antagonists.Methods A total of 128 patients with acute cerebral infarction admitted consecutively between September 1996 andDecember 2001 were involved in the study. Glutamate concentrations in plasma and cerebrospinal fluid (CSF) were analyzedby high-performance liquid chromatography (HPLC) in patients and control subjects. At the same time, Canadian StrokeScale (CSS) score and cerebral infarction volume (CTV) were also tested. Results Mean glutamate concentrations in plasma(P＜0.01) and CSF (P＜0.001) of the patients were significantly higher than in controls. Mean glutamate concentrations inplasma and CSF in 50 patients with progressing ischaemic stroke were significantly higher (P＜0.01) than in 78 patients withstable ischaemic stroke. Mean glutamate concentrations in plasma and CSF in patients with CTV ≥ 10 cm3 were significantlyhigher (P＜0.05) than in those with CTV＜10 cm3, and glutamate concentrations in CSF of 50 patients with progressingischaemic stroke evidently correlated with the CTV values (r= 0.303, P＜ 0.05). Conclusion Our findings suggest that a widewindow of preventing neurological deterioration in patients with acute ischaemic stroke exists with the use of glutamateantagonists. The CSF glutamate content may serve as an index to judge the progression of ischaemic brain injury and use ofglutamate release inhibitors.