CAJ | 학술논문

目的：探讨CT灌注结合醋甲唑胺负荷试验评估原发性高血压大鼠(spontaneous hypertensive rat，SHR)脑血管储备功能变化的可行性，并与病理实验结果对照，评价其对亚临床期脑缺血患者的临床应用价值。方法：正常对照组、SHR组各10只行常规脑CT灌注扫描及醋甲唑胺灌胃后1.5~2.0 h脑CT灌注扫描，测量负荷前后感兴趣区脑血容量(cerebral blood volume，CBV)、脑血流量(cerebral blood flow，CBF)、平均通过时间(mean transit time，MTT)及达峰时间(time to peak，TTP)值，并作统计学分析；光镜下观察大鼠脑石蜡HE染色切片小动脉管壁厚度、微循环毛细血管网情况，通过TTC染色明确各组大鼠脑组织有无脑梗死灶。结果：CT灌注扫描：两组大鼠负荷前后自身比较，正常组CBV、CBF、MTT、TTP值差异均有统计学意义(P<0.05)，且负荷状态下CBV、CBF值增加，MTT、TTP值缩短；SHR组差异均无统计学意义。组间比较，两组大鼠负荷前后CBV、CBF、MTT、TTP值差异均有统计学意义(P<0.05)，且SHR大鼠CBV、CBF值减低，MTT、TTP值延长。 HE染色示SHR组小动脉及微小动脉管壁重塑，管壁增厚、硬化，微循环毛细血管网数目相对减少。TTC染色示SHR大鼠脑组织无明确脑梗死灶。结论：SHR较正常大鼠脑血管储备减低，醋甲唑胺负荷CT灌注成像可反映脑血管储备功能改变，对亚临床期脑缺血患者的病情评估具有重要临床指导意义。
목적：탐토CT관주결합작갑서알부하시험평고원발성고혈압대서(spontaneous hypertensive rat，SHR)뇌혈관저비공능변화적가행성，병여병리실험결과대조，평개기대아림상기뇌결혈환자적림상응용개치。방법：정상대조조、SHR조각10지행상규뇌CT관주소묘급작갑서알관위후1.5~2.0 h뇌CT관주소묘，측량부하전후감흥취구뇌혈용량(cerebral blood volume，CBV)、뇌혈류량(cerebral blood flow，CBF)、평균통과시간(mean transit time，MTT)급체봉시간(time to peak，TTP)치，병작통계학분석；광경하관찰대서뇌석사HE염색절편소동맥관벽후도、미순배모세혈관망정황，통과TTC염색명학각조대서뇌조직유무뇌경사조。결과：CT관주소묘：량조대서부하전후자신비교，정상조CBV、CBF、MTT、TTP치차이균유통계학의의(P<0.05)，차부하상태하CBV、CBF치증가，MTT、TTP치축단；SHR조차이균무통계학의의。조간비교，량조대서부하전후CBV、CBF、MTT、TTP치차이균유통계학의의(P<0.05)，차SHR대서CBV、CBF치감저，MTT、TTP치연장。 HE염색시SHR조소동맥급미소동맥관벽중소，관벽증후、경화，미순배모세혈관망수목상대감소。TTC염색시SHR대서뇌조직무명학뇌경사조。결론：SHR교정상대서뇌혈관저비감저，작갑서알부하CT관주성상가반영뇌혈관저비공능개변，대아림상기뇌결혈환자적병정평고구유중요림상지도의의。
Ob jective: To explore the feasibility of perfusion CT combined with methazolamide stress test in evaluating the changes of the cerebrovascular reserve capacity of spontaneous hypertensive rat(SHR), and compared with pathological re-sults, then to evaluate the clinical application value in patients with subclinical cerebral ischemia. Methods:Totally of 10 rats in normal control group and 10 rats in SHR group underwent cerebral CT perfusion scanning before and and 1.5-2.0 h after intragastric administration of methazolamide. The cerebral blood volume(CBV),cerebral blood flow(CBF), mean transit time (MTT), time to peak(TTP) values of region of interest were measured before and after methazolamide stress test and for statis-tical analysis. The arteriolar wall thickness and microcirculation capillary network were observed under light microscope of HE staining of paraffin section. TTC staining was performed to make sure the brain without cerebral infarction. Results: CT perfusion scanning: the differences of the CBV, CBF, MTT and TTP values between the resting state and load state of the normal control group had statistical significance(P<0.05), and the CBV, CBF values increased, the MTT, TTP values short-ened in the load state. There were no statistical significant differences of the CBV, CBF, MTT and TTP values between the resting state and load state of the SHR group. The CBV, CBF, MTT and TTP values between the two groups of rats had sig-nificant differences(P<0.05) both in the resting state and the load state, and the CBV, CBF values of the SHR group de-creased, MTT, TTP values prolonged. HE staining showed that the remodeling, wall thickening and hardening of the arteri-oles and small arteries, and the relative reduction of the number of the microcirculation capillary network in the SHR group. TTC staining showed that the brain tissue of SHR had no cerebral infarction. Conclusions: The cerebrovascular reserve of the SHR decreases compared with the normal. CT perfusion combined with methazolamide stress test can reflect the change of cerebrovascular reserve, with important clinical significance on condition assessment and early intervention in patients with subclinical cerebral ischemia.