Cao Maohong, Ke Kaifu, Sun Haihua, Robertson Annette
Departmemt of Neurology, Nantong University, Nantong, China.
Acta Neurol Taiwan. 2011 Sep;20(3):172-81.
To observe the effects of Prostaglandin E1 (PGE1) on hematoma, perihematomal tissue and the impairment of neurological function in patients with hypertensive intracerebral hemorrhage (HICH).
A total of 40 patients with HICH were enrolled according to the inclusion criteria and randomly divided into two groups: the control group (n=20) and the PGE1 treatment group (n=20). In each group, 99mTc-ethyl cysteinate dimer (ECD) SPECT brain perfusion imaging was performed on days 5 and 20 after stroke, and the regional cerebral blood flow of the hematoma area, the proximal and distal regions of the hematoma surrounding tissue and the frontal and parietal lobe areas were calculated with semiquantitative methods (the Ra value was shown as an uptake ratio). The volumes of hematoma and perihematomal tissue of the subjects (low-density areas around the hematoma as observed in the skull CT) were recorded by skull CT scan. Meanwhile, the NIHSS score for each patient was assessed upon admission and on the 5th, 12th, and 20th days of hospital stay. The mRS scores of each patient were recorded on the 1st and 20th days of admission. The NIHSS and mRS assessments were also performed three months following admission.
In the PGE1 treatment group, the Ra values of the proximal and distal regions of the perihematomal tissue were significantly higher than those in prior treatment, and were significantly higher than the values in control group. The Ra values in the frontal and parietal lobes showed no significant differences before and after treatment. The volumes of hematomas in the PGE1 group were obviously reduced on the 12th and 20th days when compared with the 1st day and the 5th day, and these differences showed statistical significance. The volumes of hematomas in the control group were obviously reduced on the 20th when compared with the 1st day. On the 20th day, volumes of hematomas were significantly reduced in the PGE1 group than in control group . Moreover, the volume of perihematomal tissue in the PGE1 group was significantly reduced on the 20th day when compared with on the 5th day and the control group. NIHSS scores showed statistically significant differences on the 20th day of admission and the follow-up three months later when the PGE1 treatment group and control group were compared. mRS scores in the three-month follow-up also showed statistically significant differences between the two groups .
The application of PGE1 therapy for patients with hypertensive intracerebral hemorrhage started on the 5th day after stroke was capable of enhancing rCBF of perihematomal tissue. This treatment significantly improved the prognosis of and recovery from neurological deficits in HICH patients.
观察前列腺素E1（PGE1）对高血压性脑出血（HICH）患者血肿、血肿周围组织及神经功能损害的影响。
根据纳入标准，共纳入40例HICH患者，随机分为两组：对照组（n = 20）和PGE1治疗组（n = 20）。每组患者在卒中后第5天和第20天行99mTc-乙基半胱氨酸二聚体（ECD）SPECT脑灌注成像，采用半定量方法计算血肿区域、血肿周围组织近端和远端区域以及额叶和顶叶区域的局部脑血流量（以摄取率表示Ra值）。通过头颅CT扫描记录受试者血肿及血肿周围组织的体积（头颅CT观察到的血肿周围低密度区）。同时，在入院时及住院第5天、12天和20天评估每位患者的美国国立卫生研究院卒中量表（NIHSS）评分。记录每位患者入院第1天和第20天的改良Rankin量表（mRS）评分。入院三个月后也进行NIHSS和mRS评估。
PGE1治疗组血肿周围组织近端和远端区域的Ra值明显高于治疗前，且明显高于对照组。额叶和顶叶的Ra值治疗前后无明显差异。与第1天和第5天相比，PGE1组第12天和第20天的血肿体积明显减小，差异有统计学意义。与第1天相比，对照组第20天的血肿体积明显减小。第20天，PGE1组的血肿体积明显小于对照组。此外，与第5天及对照组相比，PGE1组第20天的血肿周围组织体积明显减小。比较PGE1治疗组和对照组，入院第20天及三个月后的随访中，NIHSS评分差异有统计学意义。两组在三个月随访时的mRS评分差异也有统计学意义。
卒中后第5天开始对高血压性脑出血患者应用PGE1治疗，能够增加血肿周围组织的局部脑血流量。该治疗显著改善了HICH患者的预后及神经功能缺损的恢复情况。
