Progression of ischaemic stroke and excitotoxic aminoacids
Progression of ischaemic stroke and excitotoxic aminoacids
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DOI：
10.1016/s0140-6736(96)04453-4
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发表时间：
1997-01-11
期刊：
影响因子：
168.9
通讯作者：
Noya, M
中科院分区：
文献类型：
--
作者：
Castillo, J;Davalos, A;Noya, M
背景
人们对卒中进展所涉及的机制知之甚少。动物研究表明，兴奋性氨基酸介导的神经元死亡与局灶性脑缺血的恶化之间存在关联。在一项对128例急性缺血性卒中患者的前瞻性研究中，我们探究了血浆和脑脊液（CSF）中谷氨酸和甘氨酸浓度与早期进展之间的关联。
方法
在我们急诊科连续收治的556例患者中，128例符合条件的缺血性卒中患者被纳入我们的研究。在卒中发病后的最初24小时内采集血液和脑脊液样本，此前的头颅计算机断层扫描已排除脑水肿。如果在纳入研究后的最初48小时内加拿大卒中量表评分（1.5 = 最大神经功能缺损，10 = 无缺损）下降1分或更多，则判定缺血性卒中处于进展状态。采用高效液相色谱法测定血浆和脑脊液中谷氨酸和甘氨酸的浓度。通过逻辑回归分析血浆和脑脊液谷氨酸浓度对进展的影响。
结果
43例（33.6%）患者患有进展性缺血性卒中。进展性卒中患者血浆和脑脊液中谷氨酸和甘氨酸的浓度高于脑梗死稳定的患者（p
Background Mechanisms involved in progression of stroke are little understood. Studies in animals have shown an association between neuronal death mediated by excitatory aminoacids and deterioration in focal cerebral ischaemia. We looked for an association between concentrations of glutamate and glycine in plasma and cerebrospinal fluid (CSF) and early progression in a prospective study of 128 patients with acute ischaemic stroke.Methods Of 556 consecutive admissions to our emergency unit, 128 eligible patients with ischaemic stroke were included in our study. Blood and CSF samples were taken within the first 24 h from stroke onset when cerebral oedema had been excluded on a previous cranial computed tomography. Ischaemic stroke was judged to be in progression if the Canadian stroke scale score (1.5=maximum neurological deficit, 10=no deficit) fell by 1 or more points during the first 48 h after inclusion. Glutamate and glycine concentrations in plasma and CSF were measured by high-performance liquid chromatography. The effect of plasma and CSF glutamate concentrations on progression was analysed by logistic regression.Findings 43 (33.6%) patients had progressing ischaemic stroke. Concentrations of glutamate and glycine in plasma and CSF were higher in patients with progressing stroke than in those with stable cerebral infarcts (p