CEREBRAL GLUCOSE-METABOLISM AS A PREDICTOR OF REHABILITATION AFTER ISCHEMIC STROKE
CEREBRAL GLUCOSE-METABOLISM AS A PREDICTOR OF REHABILITATION AFTER ISCHEMIC STROKE
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DOI：
10.1161/01.str.24.12.1784
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发表时间：
1993-12-01
期刊：
影响因子：
8.3
通讯作者：
HERHOLZ, K
中科院分区：
文献类型：
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作者：
HEISS, WD;EMUNDS, HG;HERHOLZ, K
背景和目的：缺血性卒中后的永久性神经功能缺损主要取决于梗塞的位置和大小，但社交恢复和康复也取决于梗塞外脑组织的功能状态。由于梗塞周围组织中的神经元损失和功能失活反映为代谢和代谢的变化，因此葡萄糖消耗的测量可能会产生康复能力的额外测量。方法：连续纳入 76 名首次发生单侧幕上缺血性梗塞的非糖尿病患者（48 名男性，28 名女性；平均年龄，56.7+/-14.37 岁）。在发作后 9 +/- 7.2 天神经学和临床状况稳定时，通过氟脱氧葡萄糖的正电子发射断层扫描测量非梗塞脑区域的葡萄糖脑代谢率 (CMR(glu))。中风后 21 至 77 个月（平均 50.5 +/- 11.7）个月，通过日常生活活动康复指数评估结果。 结果：评估结果时，16 名患者死亡（评分为 0），22 名患者完全康复（评分为 200），38 名患者部分改善（康复评分为 5 至 195）。年龄较小、没有高血压和心脏病，以及较高的整体、同侧和对侧 CMR (glu) 与更好的最终结果显着相关 (P=.001)，而中风后亚急性阶段的性别和神经功能缺损与最终结果无关。为了进一步评估调整临床预后变量后 CMR(glu) 的重要性，对部分康复患者的同质亚组中年龄和 CMR(glu) 对康复评分的影响进行了多元回归分析。结果表明，高血压患者的 CMR(glu) (P=.016) 与恢复呈显着正相关，而对于血压正常的患者，年龄是主要的预后因素 (P=.07)。 结论：这些结果表明，除了缺血性发作之外，中风后的结果还受到多种导致脑功能丧失的因素的显着影响。除了年龄和心脏病之外，高血压是导致广泛性动脉病并伴有神经元损失和组织损伤的重要因素。梗死区外的 CMR(glu) 与高血压受试者的功能恢复显着相关，可能反映了高血压组织损伤的程度以及随后补偿局灶性缺血损伤的能力下降。
Background and Purpose: Permanent neurological deficits after ischemic stroke are primarily determined by the location and size of an infarct, but social recovery and rehabilitation also depend on the functional status of brain tissue outside the infarct. Since neuronal loss and functional deactivation in peri-infarct tissue are reflected as changes in How and metabolism, measurement of glucose consumption may yield an additional measure of rehabilitative capacity.Methods: Seventy-six nondiabetic patients (48 men, 28 women; mean age, 56.7+/-14.37 years) with a first unilateral supratentorial ischemic infarct were consecutively enrolled. At stable neurological and clinical condition 9 +/- 7.2 days after the attack, cerebral metabolic rate of glucose (CMR(glu)) in noninfarcted brain regions was measured by positron emission tomography of fluorodeoxyglucose. Outcome was assessed 21 to 77 (mean, 50.5 +/- 11.7) months after the stroke with a rehabilitation index for daily life activities.Results: At time of assessment of outcome 16 patients had died (score, 0), 22 were completely recovered (score, 200), and 38 had partially improved (rehabilitation score, 5 to 195). Younger age, absence of arterial hypertension and cardiac disease, but also higher global, ipsilateral, and contralateral CMR(glu) were significantly related to a better final outcome (P=.001), whereas sex and neurological deficits in the subacute stage after stroke were not related to final outcome. To evaluate the significance of CMR(glu) further after adjustment for clinical prognostic variables, a multiple regression analysis of the effect of age and CMR(glu) on rehabilitation score in homogeneous subgroups of partially recovered patients was performed. It revealed a significant positive correlation of CMR(glu) (P=.016) with recovery in hypertensive subjects, while age was the dominant prognostic factor (P=.07) in patients with normal blood pressure.Conclusions: These results demonstrate that outcome after stroke is significantly influenced by several factors incapacitating brain function in addition to the ischemic attack. In addition to age and cardiac disease, hypertension is an important factor leading to widespread arteriopathy with neuronal loss and tissue damage. The significant correlation of CMR(glu) outside the infarct with functional recovery in hypertensive subjects probably reflects the extent of hypertensive tissue damage and subsequently reduced capacity to compensate for the focal ischemic insult.