Brouns Raf, Sheorajpanday Rishi, Wauters Annick, De Surgeloose Didier, Mariën Peter, De Deyn Peter P
Department of Neurology and Memory Clinic, ZNA Middelheim Hospital, Antwerp, Belgium.
Clin Chim Acta. 2008 Nov;397(1-2):27-31. doi: 10.1016/j.cca.2008.07.016. Epub 2008 Jul 19.
Accumulation of lactate in ischemic regions has been documented in acute stroke. We evaluated the relation between lactate levels in blood and cerebrospinal fluid (CSF) and ischemic stroke evolution and outcome.
Lactate was measured in blood of 187 acute ischemic stroke and TIA patients at admission, 24 h, 72 h and 7 days after stroke onset. In a subpopulation of 85 stroke patients and in 51 controls, lactate was measured in CSF. Stroke evolution was evaluated by change in the NIHSS score within the first 72 h and by occurrence of progressing stroke. At 3 months after stroke, outcome was assessed on the basis of mortality rate and the modified Rankin Scale.
We found no relation between lactate levels in blood and stroke evolution or outcome. Lactate in CSF was higher in stroke patients than in controls and correlated with stroke evolution and outcome. Multivariate regression analyses showed that CSF lactate levels, age and stroke severity are independent predictors for stroke evolution and outcome.
Lactate levels in CSF, but not in blood, are a reliable marker for metabolic crisis in acute ischemic stroke and correlate with the stroke evolution in the subacute phase and with long-term outcome.
急性卒中时，缺血区域乳酸堆积已有文献记载。我们评估了血液和脑脊液（CSF）中乳酸水平与缺血性卒中进展及预后的关系。
对187例急性缺血性卒中和短暂性脑缺血发作（TIA）患者在入院时、卒中发作后24小时、72小时和7天测定血液中的乳酸水平。在85例卒中患者的亚组和51例对照中，测定脑脊液中的乳酸水平。通过72小时内美国国立卫生研究院卒中量表（NIHSS）评分的变化以及进展性卒中的发生来评估卒中进展。卒中后3个月，根据死亡率和改良Rankin量表评估预后。
我们发现血液中的乳酸水平与卒中进展或预后无关。卒中患者脑脊液中的乳酸水平高于对照组，且与卒中进展及预后相关。多因素回归分析显示，脑脊液乳酸水平、年龄和卒中严重程度是卒中进展及预后的独立预测因素。
脑脊液中的乳酸水平而非血液中的乳酸水平是急性缺血性卒中代谢危机的可靠标志物，与亚急性期卒中进展及长期预后相关。
