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

Changes of1HMRS and blood flow dynamics in acute cerebral infarction

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 .0 5) ;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 .3 10 ,P =0 .0 0 6)。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 ;

Objective To get more diagnostic informa ti on from the acute cerebral infarct, We used1HMRS and TCD to investigate the r elationship between the metabolites in the infarct, the infarct volume, blood f low velocity and blood flow to the infarct, and the clinical neurologic deficit. MethodsFifteen patients with acute cerebral infarct underwent1HMRS and TCD examinations. Clinical neurologic deficit score was c ollected from every patient record at the time of the1HMRS and TCD study. Inf arct volume (V/ml) was determined with machine software automatically. A PRESS a cquisition was used for1HMRS. The peak areas of N,Lac,Cr,Cho in the lesi on 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 responsi ble cerebral blood flow was estimated by Vs. ResultsT here were significant decrease of N,Cr,Vm and ECBF in the lesion region when c ompared with the contralateral side( P <0.05). The inverted double peak of L ac was detected in the infarct. The reduced N in the infarct was correlated wi th the reduced Cr, Lac and the infarct volume( r =0.56,-0.55,-0.68, respecti vely). The presence of Lac was correlated with the reduced N and the large inf arct ( r =0.55). Multiple linear regression revealed that the reduced N in t he infarct and the infarct volume were dependent on each other( t =-3.310, P =0.006). Conclusion1HMRS and blood flow paramete rs in the period of the acute cerebral infarction changed significantly. The dec rease of blood flow speed and the deficiency of blood flow are the immediate cau ses of the infarct. The presence of Lac is an extremely sensitive index of the a cute cerebral ischemia. N is a factor significantly associated with the infarc t volume.