Mazibuko Ndaba, Tuura Ruth O'Gorman, Sztriha Laszlo, O'Daly Owen, Barker Gareth J, Williams Steven C R, O'Sullivan Michael, Kalra Lalit
Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AF, UK.
Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
Diagnostics (Basel). 2020 Jul 16;10(7):482. doi: 10.3390/diagnostics10070482.
Preservation of neuronal tissue is crucial for recovery after stroke, but studies suggest that prolonged neuronal loss occurs following acute ischaemia. This study assessed the temporal pattern of neuronal loss in subacute ischemic stroke patients using H magnetic resonance spectroscopy, in parallel with functional recovery at 2, 6 and 12 weeks after stroke. Specifically, we measured -acetylaspartate (NAA), choline, myoinositol, creatine and lactate concentrations in the ipsilesional and contralesional thalamus of 15 first-ever acute ischaemic stroke patients and 15 control participants and correlated MRS concentrations with motor recovery, measured at 12 weeks using the Fugl-Meyer scale. NAA in the ipsilesional thalamus fell significantly between 2 and 12 weeks (10.0 to 7.97 mmol/L, = 0.003), while choline, myoinositol and lactate concentrations increased ( = 0.025, = 0.031, = 0.001, respectively). Higher NAA concentrations in the ipsilesional thalamus at 2 and 12 weeks correlated with higher Fugl Meyer scores at 12 weeks ( = 0.004 and = 0.006, respectively). While these results should be considered preliminary given the modest sample size, the progressive fall in NAA and late increases in choline, myoinositol and lactate may indicate progressive non-ischaemic neuronal loss, metabolically depressed neurons and/or diaschisis effects, which have a detrimental effect on motor recovery. Interventions that can potentially limit this ongoing subacute tissue damage may improve stroke recovery.
神经元组织的保存对于中风后的恢复至关重要，但研究表明，急性缺血后会发生长时间的神经元丢失。本研究使用氢磁共振波谱评估了亚急性缺血性中风患者神经元丢失的时间模式，并与中风后2周、6周和12周的功能恢复情况进行了对比。具体而言，我们测量了15例首次发生急性缺血性中风患者和15例对照参与者患侧和对侧丘脑的N-乙酰天门冬氨酸（NAA）、胆碱、肌醇、肌酸和乳酸浓度，并将磁共振波谱浓度与使用Fugl-Meyer量表在12周时测量的运动恢复情况进行了关联分析。患侧丘脑的NAA在2周和12周之间显著下降（从10.0降至7.97 mmol/L，P = 0.003），而胆碱、肌醇和乳酸浓度则升高（分别为P = 0.025、P = 0.031、P = 0.001）。2周和12周时患侧丘脑较高的NAA浓度与12周时较高的Fugl-Meyer评分相关（分别为P = 0.004和P = 0.006）。鉴于样本量较小，这些结果应被视为初步结果，但NAA的逐渐下降以及胆碱、肌醇和乳酸的后期升高可能表明存在进行性非缺血性神经元丢失、代谢抑制的神经元和/或远隔效应，这些对运动恢复有不利影响。能够潜在限制这种持续的亚急性组织损伤的干预措施可能会改善中风恢复情况。
