动脉粥样硬化进展性卒中的临床研究

Clinical study on atherosclerotic atroke in progress

目的 探讨动脉粥样硬化进展性卒中的临床与影像学特点 ,人疱疹病毒IgM总阳性率 ,常规治疗和抗病毒药治疗效果。方法 对 3 9例患者进行脑CT、MRI、DSA和颈动脉超声检查 ,3 5例在常规治疗基础上应用膦甲酸钠 (PhosphonoformicAcid ,PFA) 3 .0g静脉滴注 ,每日 1次。观察临床症状与体征停止发展的日期 ,治疗后神经功能改善程度。结果 本组 3 9例患者脑CT、MRI提示脑梗死早期呈皮层或皮层下不规则斑片状病灶 ,而MRA、DSA显示颈内动脉、椎 基底动脉及其主要分支狭窄或闭塞。疱疹病毒IgM总阳性率 91.6% ,与同期住院非脑血管病患者相比差异非常显著 (P <0 .0 1)。本文 3 9例常规治疗均不能控制病情发展 ,而 3 5例应用PFA后 ,基本痊愈 2例 ,显著进步 3 0例 ,进步 3例。而未采用PFA治疗的 4例患者死亡 1例 ,恶化 3例。结论 动脉粥样硬化进展性卒中以颅内主要脑供血动脉狭窄或闭塞为主 ,疱疹病毒IgM阳性 ,病程呈进行性加重 ,应用PFA治疗有效。作者认为该病与人疱疹病毒感染密切相关 。

Objective To investigate the clinical and iconography features of atherosclerotic stroke in progress,the total positive rate of serum HSV IgM,the effects of routine treatment and antiviral therapy.Methods The CT,MRI,MRA,DSA and arteria carotis ultrasonic examination in 39 patients with stroke in progress (SIP) were carried out.35 patients,based on the routine therapy,were treated with phosphonoformic acid,3.0 g once a day,iv.The time when the progression of clinical symptoms and signs was stopped was observed,as well the improvement degree of nervous functionafter remedy.Results The CT/MRI in the 39 patients showed that the irregular blot piece focus at cerebral cortex or beneath it at the earlier stage of cerebral infarction (CI).While the MRA/DSA showed that the internal carotid/vertebral basal arteries and its major sprig stenosis or block.The total positive rate of HSV IgM was 91.6%,which was significantly different from that in patients with non cerebrovascular disease (P<0.01).Among the 35 patients treated with PFA,2 cases were basically cured,30 cases were obvious progress and 3 cases were slight progress.On the contrary,among 4 patients who were not treated with PFA,1 case was dead and 3 cases got worse.Conclusion Athrosclerotic stroke in progress was mostly caused by stenosis or block of arteriae that provide blood for cerebral tissue,in which the HSV IgM was positive and the course of disease got worse progressively,however PFA is effective in treating it.The SIP is closely related with herpes simplex virus (HSV),its pathologic mechanism is necessary to be researched further.