磁共振波谱NAA与Lac在脑梗塞各时期的临床意义

The Clinical Significance of 1HMRS with NAA and Lac in Each Period of Cerebral Infarct

目的探讨不同时期脑梗死区域内细胞代谢特点及演变规律,寻找反映脑缺血损伤的可靠指标,为临床不同时期脑梗死的治疗提供病理生理学依据。材料与方法选择100例脑梗死患者按照其发病时间分为:6小时内为超急性期10例;6-48小时为急性期52例;2天6周内为亚急性期25例;6周后为慢性期13例。采用点解析波谱序列(PRESS),TR=1500ms,TE=135ms,两侧相对应部位单体素采集。寻找N-乙酰天门冬氨酸(NAA)和乳酸(Lac)在脑梗死的各个时期的变化规律,并选取与病变对应的对侧正常区域作为对照组。结果超急性期10例均出现Lac,而NAA改变不明显;急性期52例Lac均增加,NAA显示不同程度地减少;亚急性期25例,其中17例Lac开始下降,但浓度维持较高水平,其余8例未见明显乳酸峰,NAA进一步减少;慢性期13例,其中11例仍可检测到一定浓度的Lac,2例未出现明显Lac峰。结论 NAA与Lac的变化可作为反映脑缺血损伤的可靠指标,MRS能非损伤性地监测脑梗死的物质与能量代谢规律,为临床脑梗死的治疗与预后评价提供客观依据。

Objective To discuss the cell metabolic features and the changes of metabolite in each period of cerebral infarct, and to look for the reliability index which can reflect the cerebral ischemia injury, so to provide pathophysiological basis for the clinical treatment of cerebral infarction in different periods.Mater/a/s and Methods According to the time after the attack, 100 cases selected with cerebral infarct were divided into groups： （1）superacute group,〈6h, n=10;（2） acute group, 6h-48h, n=52;（3）subacute group,2d-6w, n =25;and（4） chronic group, 〉6w, n=13. PRESS/（TR1500ms,TE135ms） and single voxel acquisition of bilateral corresponding VOL was made. Looking for the changes of NAA and Lac in each period of cerebral infarct, and the normal side was taken as control group.Results During the superacute stage （n=10）, Lac appeared,but NAA showed no marked alteration; In acute stage （n=52）,Lac was increased, NAA began to decrease in different degrees, In subacute stage（n=25）, Lac began to decrease in 17 cases but maintaining a higher level of concentlation, and Lac couldn＇t be found in the other 8 cases,NAA continued to low down; In the chronic stage（n=13）, Lac showed could still be detected in I 1 cases and couldn＇t be found in 2 cases. Conclusion The changes of NAA and Lac are reliable indexes reflecting ischemic injury. l HMRS can noninvesively monitor material and energetic metabolism in cerebral infarction , providing objective basis for clinical treatment and prognosis estimation in cerebral infarction.