Buck Brian H, Liebeskind David S, Saver Jeffrey L, Bang Oh Young, Starkman Sidney, Ali Latisha K, Kim Doojin, Villablanca J Pablo, Salamon Noriko, Yun Susan W, Razinia Tannaz, Ovbiagele Bruce
Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Room A421, Toronto, ON M4N 3M5, Canada.
Arch Neurol. 2007 Sep;64(9):1287-91. doi: 10.1001/archneur.64.9.1287.
Elevated serum calcium levels at admission in patients with stroke have been associated with less severe clinical deficits and with better outcomes; however, the relationship between serum calcium levels and volumetric measurement of cerebral infarct size on neuroimaging has not been studied, to our knowledge.
To assess the relationship between serum calcium levels at admission and initial diffusion-weighted magnetic resonance imaging (DWI) infarct volumes among patients with acute ischemic stroke.
Secondary analysis of prospectively collected hospital quality improvement data.
Tertiary university hospital.
One hundred seventy-three consecutive patients with acute ischemic stroke initially seen within 24 hours of the last known well time.
Total serum calcium levels were measured on admission and were collapsed into quartiles. The DWI lesions were outlined using a semiautomated threshold technique. The relationship between serum calcium level quartiles and DWI infarct volumes was examined using multivariate quartile regression analysis.
One hundred seventy-three patients (mean age, 70.3 years [age range, 24-100 years]; median National Institutes of Health Stroke Scale score, 4 [range, 0-38]) met the study criteria. The median DWI infarct volumes for the serum calcium level quartiles (lowest to highest quartile) were 9.42, 2.11, 1.03, and 3.68 mL. The median DWI infarct volume in the lowest serum calcium level quartile was larger than that in the other 3 quartiles (P < .005). After multivariate analysis, the median adjusted DWI infarct volumes for the serum calcium level quartiles (lowest to highest) were 8.9, 5.8, 4.5, and 3.8 mL. The median adjusted DWI infarct volume in the lowest serum calcium level quartile was statistically significantly larger than that in the other 3 quartiles (P < .05).
Higher serum calcium levels at admission are associated with smaller cerebral infarct volumes among patients with acute ischemic stroke. These results suggest that serum calcium level may serve as a clinical prognosticator following stroke and may be a potential therapeutic target for improving stroke outcome.
中风患者入院时血清钙水平升高与较轻的临床缺陷和较好的预后相关；然而，据我们所知，血清钙水平与神经影像学上脑梗死体积的测量之间的关系尚未得到研究。
评估急性缺血性中风患者入院时血清钙水平与初始扩散加权磁共振成像（DWI）梗死体积之间的关系。
对前瞻性收集的医院质量改进数据进行二次分析。
三级大学医院。
173例连续的急性缺血性中风患者，在最后一次已知健康时间的24小时内首次就诊。
入院时测量总血清钙水平，并将其分为四分位数。使用半自动阈值技术勾勒DWI病变。使用多变量四分位数回归分析检查血清钙水平四分位数与DWI梗死体积之间的关系。
173例患者（平均年龄70.3岁[年龄范围24 - 100岁]；美国国立卫生研究院卒中量表评分中位数为4[范围0 - 38]）符合研究标准。血清钙水平四分位数（从最低到最高四分位数）的DWI梗死体积中位数分别为9.42、2.11、1.03和3.68 mL。血清钙水平最低四分位数的DWI梗死体积中位数大于其他3个四分位数（P <.005）。多变量分析后，血清钙水平四分位数（从最低到最高）的调整后DWI梗死体积中位数分别为8.9、5.8、4.5和3.8 mL。血清钙水平最低四分位数的调整后DWI梗死体积中位数在统计学上显著大于其他3个四分位数（P <.05）。
急性缺血性中风患者入院时较高的血清钙水平与较小的脑梗死体积相关。这些结果表明，血清钙水平可能作为中风后的临床预后指标，并且可能是改善中风预后的潜在治疗靶点。
