SPECT对缺血性脑血管病远隔缺血预适应的疗效评价研究

Study on the evaluation of efficacy of remote ischemic preconditioning in patients with ischemic cerebrovascular disease by using SPECT

目的探讨单光子发射计算机断层(SPECT)显像对缺血性脑血管病(ICVD)患者在远隔缺血预适应疗效评价中的应用价值。方法 50例单侧颅内外动脉重度狭窄或闭塞的缺血性脑血管病患者,远隔缺血预适应(RIPC)治疗前后分别行SPECT脑血流灌注和脑葡萄糖代谢显像,分析RIPC治疗前后脑血流灌注及脑葡萄糖代谢显像病灶数量、脑血流量及脑代谢率的差异。结果 50例ICVD患者RIPC治疗后脑血流灌注异常病灶数量减少,47例(94.0%)血流灌注有不同程度增高;3例(6.0%)脑血流灌注增高患者有不同程度减低。50例ICVD患者RIPC治疗后脑葡萄糖代谢异常病灶数量增加,40例代谢减低的患者有34例(68.0%)不同程度代谢增高;10例代谢增高的患者有6例(12.0%)不同程度代谢减低。50例ICVD患者RIPC治疗前后SPECT显像比较,患侧额、顶、颞、枕叶、基底节和丘脑的血流灌注显著增高(P<0.05);额、颞、枕叶、基底节和丘脑的葡萄糖代谢显著增高(P<0.01),顶叶葡萄糖代谢增高无显著性差异(P>0.05)。结论 SPECT脑血流灌注及脑葡萄糖代谢显像对评价RIPC治疗ICVD的疗效有重要价值。

Objective To explore the efficacy of remote ischemic preconditioning（ RIPC） in patients with ischemic cerebrovascular disease by using SPECT. Methods 50 cases of ischemic cerebrovascular disease with unilateral intracranial or extracranial artery stenosis or occlusion were performed SPECT for cerebral blood flow perfusion and cerebral glucose metabolism imaging before and after RIPC. The number of lesions,semi-quantitative analysis and the difference between RIPC before and after cerebral blood flow and cerebral metabolism were qualitatively analyzed. Results After RIPC the cerebral blood flow perfusion showed the decrease in number of lesions,and the cerebral blood flow had been increased in 47（ 94. 0%） patients with reduced cerebral blood flow perfusion before RIPC; the cerebral blood flow was decreased in 3（ 6. 0%）patients with increased cerebral blood flow perfusion before RIPC. The result of cerebral glucose metabolism showed increase in the number of lesions,the brain metabolism had been increased in 40（ 68. 0%） patients with decreased glucose metabolism before RIPC,the metabolism of brain was decreased in 10（ 12. 0%） patients with increased glucose metabolism before RIPC. The difference in cerebral blood flow（ frontal,parietal,temporal,occipital,basal ganglia,and thalamus） and cerebral glucose metabolism（ frontal,temporal,occipital,basal ganglia and thalamus） had significantly been increased after RIPC,besides the cerebral glucose metabolism of the parietal lobe. Conclusion The SPECT has important value in assessing the efficacy of remote ischemic preconditioning in patients with ischemic cerebrovascular disease.