Significance of increased oxygen extraction fraction in five-year prognosis of major cerebral arterial occlusive diseases.
Significance of increased oxygen extraction fraction in five-year prognosis of major cerebral arterial occlusive diseases.
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发表时间：
1999-12
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通讯作者：
H. Yamauchi;H. Fukuyama;Y. Nagahama;H. Nabatame;M. Ueno;S. Nishizawa;J. Konishi;H. Shio
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作者：
H. Yamauchi;H. Fukuyama;Y. Nagahama;H. Nabatame;M. Ueno;S. Nishizawa;J. Konishi;H. Shio
在未标记的主要脑动脉闭塞疾病中，PET测量的氧摄取分数(OEF)增加的患者可能面临更高的脑缺血风险。然而，OEF升高的临床意义仍不清楚。这项研究调查了OEF增加是否是5年后卒中风险的独立预测因素。方法对40例症状性颈内动脉或大脑中动脉闭塞性疾病患者行PET检查，前瞻性评价脑循环局部血流动力学状态与卒中风险的关系。根据有症状性病变动脉供血侧大脑半球平均OEF-的大小，将患者分为两组：OEF增高组和OEF正常组。所有患者均随访5年，直至卒中复发或死亡。结果5年期间共发生11例，9例发生同侧缺血性卒中。OEF增高组和OEF正常组的所有缺血性卒中发生率分别为5/7和6/33。OEF增高者同侧缺血性卒中4例，OEF正常者5例。Kaplan-Meier分析显示，OEF增高者发生全卒中和同侧缺血性卒中的风险显著高于OEF正常者(分别为对数等级检验P<；0.0002和P<；0.0018)。COX比例风险模型多因素分析显示，OEF增加显著增加卒中复发：全卒中和同侧卒中的相对危险度分别为7.2%(95%可信区间，2.025.5；P<；0.005)和6.4%(95%可信区间，1.626.1；P<；0.01)。与OEF不对称相比，OEF绝对值的增加是复发缺血性卒中更好的预测指标。结论这些发现表明，OEF增加是5年后再发卒中风险的独立预测因子。识别OEF升高的患者可能对预防再发卒中有临床意义。
UNLABELLED In major cerebral arterial occlusive diseases, patients with increased oxygen extraction fraction (OEF), which is measured with PET, may be at increased risk for cerebral ischemia. However, the clinical significance of increased OEF remains unclear. This study investigated whether increased OEF is an independent predictor of 5-y risk of subsequent stroke. METHODS We prospectively evaluated the relationship between the regional hemodynamic status of cerebral circulation and the subsequent risk of stroke in 40 patients with symptomatic internal carotid or middle cerebral arterial occlusive diseases who underwent PET. Patients were divided into two hemodynamic categories according to the mean hemispheric value of OEF-in the hemisphere supplied by the artery with symptomatic disease: one group with increased OEF and one with normal OEF. All patients were followed for 5 y with medical treatment until the recurrence of stroke or death. RESULTS During 5 y, 11 total and 9 ipsilateral ischemic strokes occurred. The incidences of all ischemic strokes in patients with increased OEF and in those with normal OEF were 5 of 7 and 6 of 33 patients, respectively. There were 4 ipsilateral ischemic strokes in patients with increased OEF and 5 in those with normal OEF. Kaplan-Meier analysis revealed that the risks of all stroke and ipsilateral ischemic stroke in patients with increased OEF were significantly higher than in those with normal OEF (log-rank test; P<0.0002 and P<0.0018, respectively). Multivariate analysis with the Cox proportional hazards model showed that increased OEF significantly increased stroke recurrence: the relative risk was 7.2 (95% confidence interval [CI], 2.0-25.5; P<0.005) for all stroke and 6.4 (95% CI, 1.6-26.1; P<0.01) for ipsilateral stroke. An increase in the absolute OEF value was a better predictor of recurrent ischemic stroke than was OEF asymmetry. CONCLUSION These findings suggest that an increased OEF is an independent predictor of 5-y risk of subsequent stroke. Identification of patients with increased OEF may have clinical significance in preventing recurrent stroke.