de Courten-Myers G M, Kleinholz M, Wagner K R, Myers R E
Department of Pathology (Neuropathology), University of Cincinnati College of Medicine, OH 45267-0533.
Stroke. 1989 Dec;20(12):1707-15. doi: 10.1161/01.str.20.12.1707.
Hyperglycemia is associated with three- to fourfold larger infarcts than normoglycemia following permanent middle cerebral artery occlusion in cats. We investigated the effects of glycemia on brain outcome when middle cerebral artery blood flow was restored (clip release) after 4 hours of occlusion. Seven of 13 hyperglycemic (22 mM) and one of 12 normoglycemic (6 mM) anesthetized cats developed total middle cerebral artery territory infarcts and hemispheric edema and died of brainstem compression. The remaining six and 11 cats recovered fully and later showed no or only small infarcts. Compared with permanent occlusion, restoration of blood flow after 4 hours reduced infarct volume in all normoglycemic and hyperglycemic cats that survived, but caused a much higher proportion (54% vs. 17%) of hyperglycemic and, for the first time, one normoglycemic cat, to die of infarct extension, hemorrhagic infarct conversion, and total territory edema. Thus, clip release after 4 hours caused some cats to show reduced and others to show augmented tissue damage. Rendering cats hyperglycemic substantially worsened their outcome after reperfusion by increasing their death rate from total territory edema sevenfold. Our results demonstrate that risk/benefit analyses for recanalization efforts in humans should take serum glucose concentrations into account.
在猫永久性大脑中动脉闭塞后，高血糖症与梗死灶比正常血糖时大三至四倍有关。我们研究了在大脑中动脉闭塞4小时后恢复血流（松开夹子）时血糖对脑结局的影响。13只高血糖（22 mM）麻醉猫中有7只，12只正常血糖（6 mM）麻醉猫中有1只出现了整个大脑中动脉供血区域梗死和半球水肿，并死于脑干受压。其余6只和11只猫完全恢复，随后未出现梗死灶或仅出现小梗死灶。与永久性闭塞相比，4小时后恢复血流减少了所有存活的正常血糖和高血糖猫的梗死体积，但导致更高比例（54%对17%）的高血糖猫以及首次有1只正常血糖猫死于梗死灶扩展、出血性梗死转化和全区域水肿。因此，4小时后松开夹子导致一些猫的组织损伤减轻，而另一些猫的组织损伤加重。使猫处于高血糖状态会使它们再灌注后的结局显著恶化，因全区域水肿导致的死亡率增加了七倍。我们的结果表明，对人类再通治疗进行风险/效益分析时应考虑血清葡萄糖浓度。
