CEREBRAL GLUCOSE-METABOLISM AS A PREDICTOR OF RECOVERY FROM APHASIA IN ISCHEMIC STROKE
CEREBRAL GLUCOSE-METABOLISM AS A PREDICTOR OF RECOVERY FROM APHASIA IN ISCHEMIC STROKE
复制标题
DOI：
10.1001/archneur.1993.00540090059011
复制
发表时间：
1993-09-01
影响因子：
--
通讯作者：
PAWLIK, G
中科院分区：
文献类型：
--
作者：
HEISS, WD;KESSLER, J;PAWLIK, G
客观。-卒中后失语症患者语言功能的恢复与其最初神经功能缺损的严重程度显著相关。然而，在实际实现的改进方面仍然存在很大的可变性。为了检测有助于解释这种变异性的预测因子，使用了正电子发射断层扫描（PET）和氟脱氧葡萄糖F 18（18-F-氟脱氧葡萄糖），并通过逐步回归分析结果。应用PET显像技术，对26例左侧大脑中动脉缺血性卒中患者注射氟脱氧葡萄糖F 18后12 ~ 18天的局部糖代谢变化进行了检测。我们对26名能够进行言语激活练习的患者中的17名进行了第二次PET检查。所有患者均接受了初始和4个月的随访评估。在两项PET研究和第一语言评估期间，患者在神经科诊所住院。语言性能的后续评估进行时，患者是走动。本研究选择了26例患者（10例女性，16例男性;年龄38 - 77岁;平均值+/-SD，60+/-9.2岁）。他们的失语症是各种类型和不同的严重程度，从轻度损害到严重的全面性失语。对于变量的逐步回归分析，在静息和激活PET中分析以下变量以解释从第一至第二令牌测试的剩余方差：梗死和镜像区域、左右大脑和小脑半球、左右Broca区、左右Wernicke区和左右颞顶皮质的葡萄糖的局部脑代谢率。正如预期的那样，早期和晚期令牌测试显示出很高的相关性（.85）。逐步回归分析表明，只有静息PET的左大脑半球葡萄糖值对令牌检验回归的剩余方差有显著影响。言语激活过程中的局部代谢率对失语症的显著恢复有最大的贡献。梗死面积及其相应的镜像区域、左侧布罗卡区和整个左侧大脑半球占剩余方差的80%。这些结果不仅强调了PET激活研究在预测组织潜在储备能力中的应用，而且强调了左半球完整性在功能语言恢复中的重要性。
Objective.-The recovery of language function seen in poststroke aphasia is significantly related to the severity of the initial neurologic deficit. However, a great deal of variability still remains in the improvement that is actually achieved. To detect predictors that will help in explaining this variability, positron emission tomography (PET) and fludeoxyglucose F 18 (18-F-fluorodeoxyglucose) were used and the results were analyzed by stepwise regression.Design.-Using PET imaging after injection of fludeoxyglucose F 18, the regional changes in glucose metabolism in 26 patients at a period of 12 to 18 days following an ischemic stroke involving the left middle cerebral artery were examined. A second PET examination was performed on 17 of our 26 patients who were able to perform speech activation exercises. All patients received an initial and a 4-month follow-up evaluation of languange performance.Setting.-During the two PET studies and the first language assessment, the patients were hospitalized in a neurologic clinic. The follow-up evaluation of language performance was performed when the patients were ambulatory.Patients.-Twenty-six patients (10 women, 16 men; aged 38 to 77 years; mean+/-SD, 60+/-9.2 years) were selected in the study. Their aphasias were of various types and of varying severity ranging from mild impairment to severe global aphasia.Main Outcome Measures.-For the stepwise regression analysis of variables, the following variables were analyzed in resting and activation PET to explain residual variance from the first to the second Token Test: regional cerebral metabolic rate for glucose of infarct and mirror region, left and right cerebral and cerebellar hemispheres, left and right Broca's area, left and right Wernicke's area, and left and right temporoparietal cortex.Results.-As was expected, early and late Token Tests exhibit a high correlation (.85). The stepwise regression analysis shows that only the left cerebral hemisphere glucose value of the resting PET had significant effect on the residual variance of the Token Test regression. Regional metabolic rates during speech activation had the largest contribution to a significant recovery from aphasia. The infarct area and its corresponding mirror region, the left Broca's area, and the entire left cerebral hemisphere accounted for 80% of the residual variance.Conclusions.-These results emphasize not only the application of PET activation studies in the prediction of a tissue's potential reserve capacity but also the importance of left hemisphere integrity in the recovery of functional language.