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经药物治疗的颈内动脉或大脑中动脉闭塞患者的长期预后:乙酰唑胺试验能否预测?

Long-term prognosis of medically treated patients with internal carotid or middle cerebral artery occlusion: can acetazolamide test predict it?

作者信息

Kuroda S, Houkin K, Kamiyama H, Mitsumori K, Iwasaki Y, Abe H

机构信息

Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.

出版信息

Stroke. 2001 Sep;32(9):2110-6. doi: 10.1161/hs0901.095692.

Abstract

BACKGROUND AND PURPOSE

The importance of hemodynamic parameters for predicting outcome in patients with occlusive carotid disease remains controversial. The present study was aimed at testing the hypothesis that regional cerebrovascular reactivity (rCVR) to acetazolamide can be a reliable predictor of subsequent ischemic stroke in medically treated patients with internal carotid artery or middle cerebral artery occlusion.

METHODS

Seventy-seven symptomatic patients were enrolled in this prospective, longitudinal cohort study. All patients met inclusion criteria of cerebral angiography, no or localized cerebral infarction on MRI or CT, and no or minimal neurological deficit. Regional cerebral blood flow (rCBF) and rCVR to acetazolamide were quantitatively determined by (133)Xe SEPCT. All patients were categorized into 4 types on the basis of SPECT studies.

RESULTS

During an average follow-up period of 42.7 months, 16 total and 7 ipsilateral ischemic strokes occurred. The annual risks of total and ipsilateral stroke in patients with decreased rCBF and rCVR were 35.6% and 23.7%, respectively, risks that are higher than those in other types of patients. When strokes were categorized into patients with and without decreased rCBF and rCVR, Kaplan-Meier analysis revealed that the risks of total and ipsilateral stroke in patients with decreased rCBF and rCVR were significantly higher than in those without (P<0.0001 and P=0.0001, respectively, log-rank test). Relative risk conferred by decreased rCBF and rCVR was 8.0 (95% CI, 1.9 to 34.4) for ipsilateral stroke and 3.6 (95% CI, 1.4 to 9.3) for total stroke.

CONCLUSIONS

Decreased rCBF and rCVR to acetazolamide may identify a subgroup of patients who have a higher risk of subsequent ischemic stroke when treated medically.

摘要

背景与目的

血流动力学参数对预测闭塞性颈动脉疾病患者的预后的重要性仍存在争议。本研究旨在验证以下假设:对于接受药物治疗的颈内动脉或大脑中动脉闭塞患者,乙酰唑胺激发试验所测得的局部脑血管反应性(rCVR)可作为后续缺血性卒中的可靠预测指标。

方法

本前瞻性纵向队列研究共纳入77例有症状的患者。所有患者均符合脑血管造影的纳入标准,MRI或CT检查无梗死灶或仅有局部脑梗死,且无神经功能缺损或仅有轻微神经功能缺损。采用(133)Xe单光子发射计算机断层扫描(SEPCT)定量测定局部脑血流量(rCBF)及乙酰唑胺激发试验的rCVR。根据SPECT研究结果,将所有患者分为4型。

结果

在平均42.7个月的随访期内,共发生16例全脑缺血性卒中和7例同侧缺血性卒中。rCBF和rCVR降低的患者全脑卒中和同侧卒中的年发生率分别为35.6%和23.7%,高于其他类型患者。将卒中患者按rCBF和rCVR是否降低进行分类,Kaplan-Meier分析显示,rCBF和rCVR降低的患者全脑卒中和同侧卒中的风险显著高于未降低的患者(对数秩检验,P分别<0.0001和P = 0.0001)。rCBF和rCVR降低导致的同侧卒中相对风险为8.0(95%CI,1.9至34.4),全脑卒中相对风险为3.6(95%CI,1.4至9.3)。

结论

乙酰唑胺激发试验测得的rCBF和rCVR降低可能提示药物治疗的患者后续发生缺血性卒中的风险较高。

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