Braemswig Tim Bastian, Nolte Christian H, Fiebach Jochen B, Usnich Tatiana
Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
Berlin Institute of Health (BIH), Berlin, Germany.
Front Neurol. 2017 Nov 14;8:606. doi: 10.3389/fneur.2017.00606. eCollection 2017.
Early new ischemic lesions are common in patients with an acute ischemic stroke. These new ischemic lesions may represent the natural course of the initial stroke or events.
We hypothesized that early new ischemic lesions located outside the initially affected vascular territory would point at events. Therefore, we differentiated new ischemic lesions located outside the initially affected vascular territory from those occurring only inside the initially affected vascular territory to identify risk factors that are associated with events.
Stroke patients underwent three magnetic resonance imaging examinations (at 3-T): on admission, on the next day and 4-7 days after symptom onset (clinicaltrials.gov: NCT00715533). Diffusion-weighted imaging (DWI) lesions were delineated, coregistered, and then analyzed for new hyperintensities on follow-up examinations by raters blinded to clinical details. Patients were classified as having "new distant lesions" if new DWI lesions appeared outside or both outside and inside the initially affected vascular territory or "new local lesions" if they were only inside.
115 patients with early new DWI lesions constitute the study population. Sixteen patients (14%) had new distant lesions and 99 patients (86%) had new local lesions. In comparison between patients with new distant and new local lesions, patients with new distant lesions had significantly more often elevated glycated hemoglobin (HbA1c ≥ 6.5%; = 0.022).
Our data indicate that patients with elevated HbA1c have an increased risk for new, ischemic lesions in the acute phase after an ischemic stroke.
早期新发缺血性病灶在急性缺血性卒中患者中很常见。这些新发缺血性病灶可能代表初始卒中的自然病程或其他事件。
我们假设位于初始受累血管区域之外的早期新发缺血性病灶提示其他事件。因此，我们区分了位于初始受累血管区域之外的新发缺血性病灶与仅发生在初始受累血管区域内的病灶，以确定与其他事件相关的危险因素。
卒中患者接受了三次3-T磁共振成像检查（入院时、次日以及症状发作后4-7天；clinicaltrials.gov：NCT00715533）。对扩散加权成像（DWI）病灶进行勾画、配准，然后由对临床细节不知情的评估人员在后续检查中分析新出现的高信号。如果新的DWI病灶出现在初始受累血管区域之外或内外均有，则患者被分类为有“新的远处病灶”；如果仅在内部出现，则分类为“新的局部病灶”。
115例有早期新发DWI病灶的患者构成研究人群。16例患者（14%）有新的远处病灶，99例患者（86%）有新的局部病灶。在新的远处病灶患者和新的局部病灶患者之间比较，新的远处病灶患者糖化血红蛋白升高（HbA1c≥6.5%）的情况显著更常见（P = 0.022）。
我们的数据表明，糖化血红蛋白升高的患者在缺血性卒中急性期出现新的、远处缺血性病灶的风险增加。
