CAJ | 학술논문

目的探讨急性脑梗死患者超早期CT灌注成像(CTP)在诊断中的应用价值及其与患者临床预后的关系；并检测发病时间与CTP缺血参数的相关性.方法对2006年1月至2008年5月首都医科大学宣武医院神经内科急诊就诊的75例发病8h内的前循环急性脑梗死患者进行CT平扫、CTP检查,分别在发病当天、发病14 d、发病90d采用美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)、改良的Rankin量表(mRS)评价临床神经功能缺损、日常生活能力及预后功能残疾水平.结果 (1)超早期前循环脑梗死患者发病时间的长短与CTP各参数无相关性；(2)患者缺血区脑血流量(CBF)异常面积与发病8h内(r=0.391,P＜0.001)、发病14 d(r =0.564,P＜0.001)、发病90d的NIHSS(r=0.549,P＜0.001)和BI以及mRS评分均有相关性,脑血容量(CBV)异常面积和达峰时间(TTP)异常面积也与三次的NIHSS、BI和mRS评分有相关性.结论研究证明急性脑血管病起病8h内,发病时间不是推断脑梗死缺血程度和范围最敏感的指标；CTP可以成为评价急性脑梗死患者脑梗死组织缺血程度和范围的依据之一,并可据此推断患者的功能预后情况,其中灌注异常面积是最为敏感的预测指标.
목적 탐토급성뇌경사환자초조기CT관주성상(CTP)재진단중적응용개치급기여환자림상예후적관계；병검측발병시간여CTP결혈삼수적상관성.방법 대2006년1월지2008년5월수도의과대학선무의원신경내과급진취진적75례발병8h내적전순배급성뇌경사환자진행CT평소、CTP검사,분별재발병당천、발병14 d、발병90d채용미국국립위생연구원졸중량표(NIHSS)、Barthel지수(BI)、개량적Rankin량표(mRS)평개림상신경공능결손、일상생활능력급예후공능잔질수평.결과 (1)초조기전순배뇌경사환자발병시간적장단여CTP각삼수무상관성；(2)환자결혈구뇌혈류량(CBF)이상면적여발병8h내(r=0.391,P＜0.001)、발병14 d(r =0.564,P＜0.001)、발병90d적NIHSS(r=0.549,P＜0.001)화BI이급mRS평분균유상관성,뇌혈용량(CBV)이상면적화체봉시간(TTP)이상면적야여삼차적NIHSS、BI화mRS평분유상관성.결론 연구증명급성뇌혈관병기병8h내,발병시간불시추단뇌경사결혈정도화범위최민감적지표；CTP가이성위평개급성뇌경사환자뇌경사조직결혈정도화범위적의거지일,병가거차추단환자적공능예후정황,기중관주이상면적시최위민감적예측지표.
Objective To explore the diagnostic valves of computed tomography perfusion imaging (CTP) in hyperacute cerebral infarction patients and examine the correlation of time period from symptom onset to examination and CTP parameters.Methods Non-enhancement CT and CTP were performed on 75 patients with acute cerebral infarction of internal carotid system within 8 hours of symptom onset at our department from January 2006 to May 2008.National Institute of Health Stroke Scale score (NIHSS),Barthel index (BI) and modified Rankin scale(mRS) were assessed at the same day,days 14 and 90 after stroke onset respectively for neurological function impairment,activity of daily living and extent of disability in prognosis.Results ( 1 ) All CTP parameters in ischemic region had no correlation with time period from symptom onset to examination (P ＞ 0.05 ).No significant differences were found between the patients with ＞3 hours and ＜ 3 hours after stroke onset in terms of the above parameters; (2) the areas of CBF ( cerebral blood flow) on ischemic region significantly correlated with NIHSS at the day of symptom onset (r =0.391,P＜0.001),Day 14 (r =0.564,P ＜0.001) and Day 90 (r =0.549,P ＜0.001) after symptom onset.CBV (cerebral blood volume) and TTP (time-to-peak) on ischemic region significantly correlated with the evaluation indices of predicting clinical outcomes at the day of symptom onset,Days 14 and 90 ( P ＜0.01).CBF,CBV,rCBF (regional CBF) and rCBV (regional CBV) correlated only with some of the clinical outcome scores.Conclusion Time period after symptom onset can not reflect the ischemic extent and volume of cerebral infarction.But CTP may evaluate the severity and prognosis of acute cerebral infarction patients.The area of abnormal perfusion is the most sensitive parameter.