【摘要】 目的探索急性脑梗死(ACI)病人溶栓前后缺血半暗带(IP)相对表观弥散系数(rADC)的变化及意义。方法按照PWI/DWI错配原理入选具有IP的ACI病人60例,随机分为实验组及对照组各30例,分别给予动脉介入溶栓及静脉溶栓。根据DWI异常信号的高低选取梗死核心区、核心区边缘、梗死核心区与边缘之间、梗死区外周4个点,并测量手术前后4点的rADC。用美国国立卫生研究院卒中量表(NIHSS)进行神经功能评分,并将术后NIHSS评分及住院时间与rADC进行相关性分析。结果术前两组病人以上4点的rADC均无统计学差异(P>0.05);rADC从梗死核心区到梗死区外周呈单调递增。除梗死核心区外,术后实验组其余3点的rADC均高于对照组(均P<0.05)。两组的并发症发生率无统计学差异(均P>0.05);实验组的NIHSS评分及住院时间均少或短于对照组(P=0.016,P=0.000)。术后rADC与NIHSS评分及住院时间均呈显著负相关性(均P=0.000)。结论 IP区的rADC越高代表脑细胞生命力越强,rADC可量化评价溶栓的疗效且表明动脉介入溶栓效果优于静脉溶栓。更多还原

【Abstract】 Objective To explore the change and significance of relative apparent diffusion coefficient(rADC) in the ischemic penumbra(IP) before and after thrombolysis in the patients with acute cerebral infarction(ACI).Methods According to mismatch mechanism of PWI/DWI,60 ACI patients with IP were selected and randomly divided into the experimental group and control group,30 each,and the two groups were given interventional thrombolysis(IVT) in the cerebral artery and intravenous thrombolysis respectively.Based on abnormal signal of DWI,4 regions of interest(ROI) were chosen including the infarct core region,edge of the core region,land between the core region and edge,and peri-infarct area.The rADC of the above 4 points was calculated before and after thrombolysis.The neural function was assessed via National institute of health stroke scale(NIHSS).Besides,the correlations between NIHSS scores and rADC and between hospital stays(HS) and rADC were analyzed.Results There was no difference in rADC of above 4 points between the two groups before operation(all P>0.05).The rADC increased monotonically from the infarct core region to the peri-infarct area.Except the infarct core region,the rADC at the other 3 points in experimental group was higher than that in control group after operation(all P<0.05).There was no difference in complication rates between the two groups(all P> 0.05),and the NIHSS scores and HS in experimental group were lower or shorter than those in control group(P=0.016,P=0.000 respectively).The rADC at above 4 points negatively correlated with both NIHSS scores and HS after operation(all P=0.000).Conclusions The higher rADC in the IP indicates the stronger vitality of brain cells.The rADC can evaluate the outcome of thrombolysis as a quantitative predictor and the results show that outcome of IVT is better than that of intravenous thrombolysis.更多还原