李华钢，章军建，姜健，刘煜敏.通过1H磁共振波谱和经颅多普勒超声观察急性脑梗死患者早期代谢物及血流动力学的变化[J].中华物理医学与康复杂志,2003,(11):.-
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| 通过1H磁共振波谱和经颅多普勒超声观察急性脑梗死患者早期代谢物及血流动力学的变化 |
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| DOI： |
| 中文关键词: 急性脑梗死 磁共振波谱 经颅多普勒超声 代谢物 |
| 英文关键词: Acute cerebral infarction Magnetic resonance spectroscopy Transcranial Doppler ultrasound Metabolite |
| 基金项目:国家自然基金资助课题（No.3027483） |
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| 中文摘要: |
| 目的利用1H磁共振波谱（1HMRS）和经颅多普勒超声（TCD）研究脑梗死早期代谢物、梗死大小、血流速度、血流量的变化及与临床神经功能缺损的相互关系，为脑梗死早期诊断提供更多信息。 方法15例急性脑梗死患者行1HMRS和TCD检查，同时对临床神经功能缺损进行评分，计算脑梗死灶容积V（ml）。1HMRS选择PRESS序列，检测比较病灶区和对侧相应部位N=乙酰天门冬氨酸（NAA）、乳酸（Lac）、肌酸（Cr）、含胆碱化合物（Cho）各谱线下面积的变化。TCD探测颅内动脉血流收缩期峰速（Vs）、峰值平均速度（Vm）等，并由此估算病灶责任血管血流量。 结果梗死病灶中NAA和Cr含量、Vm、血流量与对侧相应部位比较下降明显，差异有显著意义(P<0.05)；在病灶侧均可检测到倒置的Lac双峰。NAA与Cr、Lac、V之间存在相关性(r分别为0.56，-0.55，-0.68)。Lac与V之间存在相关性(r=0.55)。多元直线回归分析显示，急性脑梗死灶内NAA的减少与梗死灶容积V之间存在相互依存关系(t=-3.310,P=0.006)。 结论脑梗死早期代谢物和血流动力学发生了较明显的变化。血流速度的减慢、血流量的不足是导致脑梗死的直接原因。而Lac的出现是早期脑缺血灵敏性极高的指标；NAA为反映梗死灶容积大小的最主要因素。 |
| 英文摘要: |
| Objective To get more diagnostic information from the acute cerebral infarct, We used 1HMRS and TCD to investigate the relationship between the metabolites in the infarct， the infarct volume, blood flow velocity and blood flow to the infarct, and the clinical neurologic deficit. MethodsFifteen patients with acute cerebral infarct underwent 1HMRS and TCD examinations. Clinical neurologic deficit score was collected from every patient record at the time of the 1HMRS and TCD study. Infarct volume (V/ml) was determined with machine software automatically. A PRESS acquisition was used for 1HMRS. The peak areas of NAA，Lac，Cr，Cho in the lesion region were compared with those in the contralateral side. TCD was performed for measuring Vs, Vm of encephalic blood vessels on both sides, and the responsible cerebral blood flow was estimated by Vs. ResultsThere were significant decrease of NAA,Cr,Vm and ECBF in the lesion region when compared with the contralateral side（P<0.05）. The inverted double peak of Lac was detected in the infarct. The reduced NAA in the infarct was correlated with the reduced Cr, Lac and the infarct volume(r=0.56，-0.55，-0.68, respectively). The presence of Lac was correlated with the reduced NAA and the large infarct (r=0.55). Multiple linear regression revealed that the reduced NAA in the infarct and the infarct volume were dependent on each other(t=-3.310, P=0.006). Conclusion1HMRS and blood flow parameters in the period of the acute cerebral infarction changed significantly. The decrease of blood flow speed and the deficiency of blood flow are the immediate causes of the infarct. The presence of Lac is an extremely sensitive index of the acute cerebral ischemia. NAA is a factor significantly associated with the infarct volume. |
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