CAJ | 학술논문

目的探讨急性缺血性脑卒中(AIS)患者临床-弥散不匹配(CDM)规律,并分析其与短期临床结局的关系.方法本研究为前瞻性研究,选择2011年3月至2012年3月56例发病72 h内收入北京中医药大学东方医院脑病科住院的AIS患者,并在发病1周内完成头颅核磁(MRI)检查,确诊为大脑中动脉(MCA)供血区域梗死,采用计算机软件半自动方法计算其DWI梗死容积,并分别在入院时、入院第7、15、30天分别对患者进行美国国立卫生研究院卒中量表(NIHSS)评分,改良Rankin量表(mRS)评分.非参数变量之间采用斯皮尔曼等级相关检验进行相关性分析.CDM组与无CDM 组之间的非参数变量比较采用Mann-Whitney rank-sum检验.结果 28.6%的AIS患者存在CDM,发病72 h内行MRI检查的AIS患者中,CDM出现比例为36.3%,而72 h后行MRI检查的患者中,仅有17.4%的患者存在CDM.50.0%的CDM组患者获得良好神经学结局,而无CDM组仅有6.7%的患者获得良好神经学结局,差异有统计学意义(P=0.001);所有AIS患者NIHSS评分与DWI梗死容积具有很好的相关性(rs=0.721,P=0.009),但无CDM组(rs=0.847,P=0.000)NIHSS评分与DWI容积相关性优于存在CDM组(rs=0.610,P=0.012);存在CDM和无CDM的患者在良好临床结局、死亡例数、神经恶化方面差异无统计学意义.结论 AIS发病1周内,仍然可能存在CDM;虽然存在CDM的患者与无CDM的患者在短期临床结局差异无统计学意义;神经学结局可能优于无CDM组.
목적 탐토급성결혈성뇌졸중(AIS)환자림상-미산불필배(CDM)규률,병분석기여단기림상결국적관계.방법 본연구위전첨성연구,선택2011년3월지2012년3월56례발병72 h내수입북경중의약대학동방의원뇌병과주원적AIS환자,병재발병1주내완성두로핵자(MRI)검사,학진위대뇌중동맥(MCA)공혈구역경사,채용계산궤연건반자동방법계산기DWI경사용적,병분별재입원시、입원제7、15、30천분별대환자진행미국국립위생연구원졸중량표(NIHSS)평분,개량Rankin량표(mRS)평분.비삼수변량지간채용사피이만등급상관검험진행상관성분석.CDM조여무CDM 조지간적비삼수변량비교채용Mann-Whitney rank-sum검험.결과 28.6%적AIS환자존재CDM,발병72 h내행MRI검사적AIS환자중,CDM출현비례위36.3%,이72 h후행MRI검사적환자중,부유17.4%적환자존재CDM.50.0%적CDM조환자획득량호신경학결국,이무CDM조부유6.7%적환자획득량호신경학결국,차이유통계학의의(P=0.001);소유AIS환자NIHSS평분여DWI경사용적구유흔호적상관성(rs=0.721,P=0.009),단무CDM조(rs=0.847,P=0.000)NIHSS평분여DWI용적상관성우우존재CDM조(rs=0.610,P=0.012);존재CDM화무CDM적환자재량호림상결국、사망례수、신경악화방면차이무통계학의의.결론 AIS발병1주내,잉연가능존재CDM;수연존재CDM적환자여무CDM적환자재단기림상결국차이무통계학의의;신경학결국가능우우무CDM조.
Objective To explore the law of clinical-diffusion mismatch (CDM) among patients with acute ischemic stroke(AIS)and analyze the relationships between CDM and short-term clinical outcomes. Methods A prospective study was conducted for 56 patients with AIS admitted into our hospital within 72 hours from March 2011 to March 2012. And brain magnetic resonance imaging (MRI) examinations were completed within one week. All cases were diagnosed with infarction in the area of middle cerebral artery (MCA). The diffusion-weighted imaging (DWI) volume was calculated by semi-automatic method. Also the scores of National Institutes of Health stroke Scale (NIHSS) and modified Rankin Scale (mRS) were scored at baseline, days 7, 15, 30 post-admission respectively. The non-parametric variables were analyzed by Spearman′s rank correlation. And the differences for non-parametric variables between CDM and non-CDM groups were analyzed by Mann-Whitney rank-sum test. Results A total of 16/56(28.6%) patients showed CDM. The CDM ratios of the patients undergoing MRI within 72 hours after onset and those beyond 72 hours after onset were 36.3% and 17.4% respectively. Also 50.0% of those with CDM had favorite neurological outcomes. While for the other group without CDM, only 6.7% did so. The differences were significant (P=0.001). The correlations for all AIS patients between NIHSS scores and DWI volume were strong (rs=0.721, P=0.009). Specifically, the correlations for without CDM group(rs=0.847, P=0.000)were stronger than those of with CDM group (rs=0.610, P=0.012). No significant inter-group differences existed in favorite clinical outcome, mortality case or neurological deterioration. Conclusion CDM still occurs within 1 week after onset among patients with AIS. Although no significant differences exist in favorite clinical outcome between patients with CDM and without CDM, the CDM group may improve more in NIHSS scores and have better neurological outcomes.