颅内动脉狭窄患者行远隔缺血后适应治疗的单光子发射计算机断层摄影评价研究

Value of single photon emission CT in assessment of intracranial arterial stenosis patients undergoing limb ischemic postconditioning

目的通过观察缺血性脑卒中患者行肢体缺血后适应治疗前后脑血流灌注及葡萄糖代谢变化,了解单光子发射计算机断层摄影（SPECT）在肢体缺血后适应患者疗效评价中的价值。方法连续选择2009~2011年在北京宣武医院脑卒中治疗中心接受治疗的67例脑卒中患者。入组患者被随机分为2组：后适应组43例和对照组24例,治疗前及治疗后6个月分别行SPECT检查。结果 2组患者治疗前脑血流灌注及脑葡萄糖代谢显像,患侧额、颞、顶、枕叶、基底节和丘脑病灶分布无统计学差异（P〉0.05）。后适应组患者基底节（0.97±0.10 vs 0.93±0.09,P=0.000）和丘脑（0.99±0.09 vs 0.95±0.09,P=0.003）治疗后放射性计数比值较治疗前明显升高（P〈0.05）。结论肢体缺血后适应治疗能改善缺血脑组织对缺血的耐受,通过SPECT检查发现经肢体缺血后适应治疗的患者基底节和丘脑血流灌注改善明显。

Objective To study the value of single photon emission computed tomography in assessment of ischemic stroke patients undergoing limb ischemic postconditioning by observing their brain blood perfusion and glucose metabolism.Methods Sixty-seven ischemic stroke patients admitted to our hospital from 2009 to 2011were randomly divided into limb ischemic postconditioning group（n=43）and control group（n=24）.The patients underwent single photon emission computed tomography before and 6months after treatment.Results No significant difference was found in brain blood perfusion and glucose metabolism in frontal,temporal,apical,occipital lobes,basal ganglia and thalamus between the two groups before treatment（P〉0.05）.However,the blood perfusion in basal ganglia and thalamus was significantly higher in limb ischemic postconditioning group after treatment than before treatment（0.97±0.10 vs 0.93±0.09,0.99±0.09 vs0.95±0.09,P〈0.05）.Conclusion Limb ischemic postconditioning can improve the tolerance of brain tissues to ischemia.Single photon emission computed tomography can show the blood flow perfusion in basal ganglia and thalamus of patients undergoing limb ischemic postconditioning.