PROGRESSIVE DERANGEMENT OF PERIINFARCT VIABLE TISSUE IN ISCHEMIC STROKE
PROGRESSIVE DERANGEMENT OF PERIINFARCT VIABLE TISSUE IN ISCHEMIC STROKE
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DOI：
10.1038/jcbfm.1992.29
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发表时间：
1992-03-01
影响因子：
6.3
通讯作者：
WIENHARD, K
中科院分区：
文献类型：
--
作者：
HEISS, WD;HUBER, M;WIENHARD, K
16 名患者在半球缺血性中风发作后 6-48 小时（平均 23）小时内以及 13-25（平均 15.6）天后再次接受了多示踪剂正电子发射断层扫描 (PET) 研究。 每次均采用标准方法测量脑血流量（CBF）、脑血容量（CBV）、脑氧代谢率（CMRO2）、氧提取分数（OEF）和脑葡萄糖代谢率（CMR（glc）），并使用三维对齐程序对两项研究中获得的脑切片进行匹配。 在匹配的脑切片上，勾勒出梗塞和梗塞周围组织的感兴趣区域（ROI）、对侧镜像区域和主要脑结构。 在第一项研究中，梗塞核心区域的血流量和代谢显着低于相应的对侧区域，并且在观察期间没有变化。 在梗死周围组织中，CMRO2 在第一次测量时适度下降；随着时间的推移，CMRO2 逐渐恶化，但流量没有变化。 当根据早期扫描中增加的 OEF（比相应对侧区域高 25 +/- 29.8%）选择梗死周围区域时，CBF 显着降低（23 +/- 6.6%），而 CMRO2 仅显示与镜像区域略有差异。 在观察期内，CBF 有所改善，但 CMRO2、OEF 和 CMR(glc) 却恶化。 只有在 OEF 增加和 CMRO2 轻微受损的少数区域中，代谢保持接近正常值。 这些来自在可重复定义的组织区室中重复 PET 研究的数据提供了中风后 48 小时内缺血边界区域中存活组织的证据。 虽然这种存活的梗塞周围组织表现出有效治疗缺血性中风的一些潜力，但目前可用的治疗常规无法阻止随后的代谢紊乱和进展至坏死。 识别活组织的多示踪剂 PET 研究对于开发有效治疗缺血性中风的方法可能具有价值。
Sixteen patients were studied by multitracer positron emission tomography (PET) within 6-48 (mean of 23) h of onset of a hemispheric ischemic stroke and again 13-25 (mean of 15.6) days later. Cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral metabolic rate of oxygen (CMRO2), oxygen extraction fraction (OEF), and cerebral metabolic rate of glucose (CMR(glc)) were measured each time by standard methods, and the sets of brain slices obtained at the two studies were matched using a three-dimensional alignment procedure. On matched brain slices, regions of interest (ROIs) for infarct and peri-infarct tissue, contralateral mirror regions, and major brain structures were outlined. In the core of infarction, blood flow and metabolism were significantly lower than in the corresponding contralateral regions at the first study, and did not change during the observation period. In the peri-infarct tissue, CMRO2 was moderately decreased at the first measurement; over time, the CMRO2 deteriorated progressively while flow did not change. When peri-infarct regions were selected on the basis of increased OEF (25 +/- 29.8% above corresponding contralateral regions) on the early scans, the CBF was significantly decreased (23 +/- 6.6%) while the CMRO2 showed only a slight difference from the mirror region. Within the observation period, the CBF improved but the CMRO2, OEF, and CMR(glc) deteriorated. Only in a few regions with increased OEF and slightly impaired CMRO2 was metabolism preserved close to normal values. These data from repeat PET studies in reproducibly defined tissue compartments furnish evidence of viable tissue in the border zone of ischemia up to 48 h after stroke. While this viable peri-infarct tissue exhibits some potential for effective treatment of ischemic stroke, therapeutic routines available today cannot prevent subsequent metabolic derangement and progression to necrosis. Multitracer PET studies identifying viable tissue could be of value in the development of effective treatment of ischemic stroke.