中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2015年
10期
850-854
,共5页
周峰%刘宇恺%周俊山%施洪超
週峰%劉宇愷%週俊山%施洪超
주봉%류우개%주준산%시홍초
脑缺血%卒中%血栓溶解疗法%磁共振成像%时间
腦缺血%卒中%血栓溶解療法%磁共振成像%時間
뇌결혈%졸중%혈전용해요법%자공진성상%시간
Brain ischemia%Stroke%Thrombolytic therapy%Magnetic resonance imaging%Time
目的 评价多模磁共振弥散加权成像(DWI)-灌注加权成像(PWI)不匹配对发病在4.5h内急性缺血性脑卒中患者静脉溶栓预后的影响.方法 入选从发病到完成多模MRI检查(T1 WI,T2WI,DWI,PWI)在4.5h以内的前循环脑梗死患者,根据检查结果分为DWI-PWI不匹配组与DWI-PWI匹配组,对所有患者在4.5h内采用重组组织型纤溶酶原激活剂行静脉溶栓治疗.溶栓后24 h复查头颅CT排除有无出血并随访3个月.采用改良Rankin量表(mRS)评分评估两组患者神经功能恢复情况,并观察比较总的死亡与症状性颅内出血(sICH)发生率.结果 共入选63例患者,其中DWI-PWI不匹配组41例,DWI-PWI匹配组22例.两组患者3个月后mRS评分0～1分者分别为29例(70.7％)和9例(40.9％),差异有统计学意义(x2=5.32,P=0.021);而两组患者3个月内死亡及sICH的总发生率分别为9.8％和13.6％,差异无统计学意义(x2=0.22,P=0.640).结论 在溶栓时间窗内多模磁共振DWI-PWI不匹配者静脉溶栓治疗效果优于DWI-PWI匹配者,基于多模MRI指导的静脉溶栓个性化治疗值得临床推荐.
目的 評價多模磁共振瀰散加權成像(DWI)-灌註加權成像(PWI)不匹配對髮病在4.5h內急性缺血性腦卒中患者靜脈溶栓預後的影響.方法 入選從髮病到完成多模MRI檢查(T1 WI,T2WI,DWI,PWI)在4.5h以內的前循環腦梗死患者,根據檢查結果分為DWI-PWI不匹配組與DWI-PWI匹配組,對所有患者在4.5h內採用重組組織型纖溶酶原激活劑行靜脈溶栓治療.溶栓後24 h複查頭顱CT排除有無齣血併隨訪3箇月.採用改良Rankin量錶(mRS)評分評估兩組患者神經功能恢複情況,併觀察比較總的死亡與癥狀性顱內齣血(sICH)髮生率.結果 共入選63例患者,其中DWI-PWI不匹配組41例,DWI-PWI匹配組22例.兩組患者3箇月後mRS評分0～1分者分彆為29例(70.7％)和9例(40.9％),差異有統計學意義(x2=5.32,P=0.021);而兩組患者3箇月內死亡及sICH的總髮生率分彆為9.8％和13.6％,差異無統計學意義(x2=0.22,P=0.640).結論 在溶栓時間窗內多模磁共振DWI-PWI不匹配者靜脈溶栓治療效果優于DWI-PWI匹配者,基于多模MRI指導的靜脈溶栓箇性化治療值得臨床推薦.
목적 평개다모자공진미산가권성상(DWI)-관주가권성상(PWI)불필배대발병재4.5h내급성결혈성뇌졸중환자정맥용전예후적영향.방법 입선종발병도완성다모MRI검사(T1 WI,T2WI,DWI,PWI)재4.5h이내적전순배뇌경사환자,근거검사결과분위DWI-PWI불필배조여DWI-PWI필배조,대소유환자재4.5h내채용중조조직형섬용매원격활제행정맥용전치료.용전후24 h복사두로CT배제유무출혈병수방3개월.채용개량Rankin량표(mRS)평분평고량조환자신경공능회복정황,병관찰비교총적사망여증상성로내출혈(sICH)발생솔.결과 공입선63례환자,기중DWI-PWI불필배조41례,DWI-PWI필배조22례.량조환자3개월후mRS평분0～1분자분별위29례(70.7％)화9례(40.9％),차이유통계학의의(x2=5.32,P=0.021);이량조환자3개월내사망급sICH적총발생솔분별위9.8％화13.6％,차이무통계학의의(x2=0.22,P=0.640).결론 재용전시간창내다모자공진DWI-PWI불필배자정맥용전치료효과우우DWI-PWI필배자,기우다모MRI지도적정맥용전개성화치료치득림상추천.
Objective To assess the relationship between diffusion-weighted imaging-perfusionweighted imaging (DWI-PWI) mismatch and the prognosis of patients with acute anterior circulation ischemic stroke receiving intravenous thrombolysis.Methods Patients with acute anterior circulation ischemic stroke who finished multimode MRI (T1 WI,T2 WI,DWI,PWI) within 4.5 hours after disease onset were recruited in this study.They were divided into DWI-PWI mismatched and matched groups.All patients received intravenous thrombolysis using recombinant tissue type plasminogen activator (rt-PA).Head CT was performed 24 hours later to exclude cerebral hemorrhage,and the patients were followed up for 3 months.The improvement of neurological function,the rate of death and symptomatic intracranial hemorrhage (sICH) were recorded.Results A total of 63 patients were recruited in this study,of which 41 patients presented DWI-PWI mismatch while 22 patients presented DWI-PWI match.Three months later,the rate of the improvement of neurological function in the DWI-PWI mismatched group was significantly higher than that in the DWI-PWI matched group (70.7％ vs 40.9％,x2 =5.32,P =0.021).Of note,no significant difference in the rate of death and sICH was found between DWI-PWI mismatched and matched groups (9.8％ vs 13.6％,x2 =0.22,P =0.640).Conclusions Compared with DWI-PWI matched group,the DWI-PWI mismatched group has better prognosis after receiving intravenous tbrombolysis.The results provide more direct evidence supporting the application of intravenous thrombolysis under the guidance of multimode MRI in acute anterior circulation ischemic stroke.
