Chang S-W, Huang Y-C, Lin L-C, Yang J-T, Weng H-H, Tsai Y-H, Lee T-H
Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Neurology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Eur J Neurol. 2016 Mar;23(3):494-500. doi: 10.1111/ene.12841. Epub 2016 Jan 23.
Recent large series studies have demonstrated that dehydration is common amongst stroke subjects and is associated with poor outcome. However, the effects of hydration status on the development of collaterals have never been discussed. In this study, the hypothesis that hydration status is an important factor for developing collaterals after acute middle cerebral artery (MCA) infarction was tested.
Eighty-seven patients with acute infarction due to occlusion of the MCA were enrolled. Two collateral markers, posterior cerebral artery (PCA) laterality and fluid-attenuated inversion recovery hyperintense vessels (HVs) were assessed from magnetic resonance imaging. Dehydration status was defined by a nitrogen to creatinine ratio ≧ of 15. The associations between dehydration status and the development of collaterals were estimated.
Sixty-one of 87 patients (70.1%) were identified as dehydrated. The development of PCA laterality and HVs shows a significant difference between dehydrated and euhydrated patients. A serum nitrogen to creatinine ratio <15, diastolic blood pressure and the presence of a dense MCA on computed tomography were significantly associated with the development of PCA laterality. A serum nitrogen to creatinine ratio <15, the initial National Institutes of Health Stroke Scale score, the presence of a dense MCA and calcifications of the internal carotid artery on computed tomography were significantly associated with the development of HVs. Dehydration remained an independent negative predictor for the development of PCA laterality and HVs in the multivariate analysis.
Hydration status is associated with the development of collateral flow after acute MCA occlusion. This preliminary study provides an imaging clue that hydration status and early hydration therapy could be important for acute stroke management.
近期的大型系列研究表明，脱水在中风患者中很常见，且与预后不良相关。然而，水化状态对侧支循环形成的影响从未被探讨过。在本研究中，我们检验了水化状态是急性大脑中动脉（MCA）梗死后侧支循环形成的重要因素这一假设。
纳入87例因MCA闭塞导致急性梗死的患者。从磁共振成像评估两个侧支循环标志物，即大脑后动脉（PCA）的优势侧和液体衰减反转恢复高信号血管（HVs）。脱水状态通过氮肌酐比值≧15来定义。评估脱水状态与侧支循环形成之间的关联。
87例患者中有61例（70.1%）被确定为脱水。PCA优势侧和HVs的形成在脱水和非脱水患者之间存在显著差异。血清氮肌酐比值<15、舒张压以及计算机断层扫描上MCA致密影的存在与PCA优势侧的形成显著相关。血清氮肌酐比值<15、初始美国国立卫生研究院卒中量表评分、计算机断层扫描上MCA致密影的存在以及颈内动脉钙化与HVs的形成显著相关。在多变量分析中，脱水仍然是PCA优势侧和HVs形成的独立负性预测因素。
水化状态与急性MCA闭塞后侧支循环血流的形成相关。这项初步研究提供了一个影像学线索，即水化状态和早期水化治疗可能对急性卒中管理很重要。
