Furlan M, Marchal G, Viader F, Derlon J M, Baron J C
INSERM U. 320, Caen, France.
Ann Neurol. 1996 Aug;40(2):216-26. doi: 10.1002/ana.410400213.
We prospectively tested the hypothesis that early recovery after ischemic stroke depends on the ultimate survival of functionally impaired, critically ischemic (i.e., "penumbral") tissue. From a series of 26 consecutive patients studied with positron emission tomography within 18 hours of first-ever stroke in the middle cerebral artery territory, all 11 survivors to the 2-month end point who exhibited increased oxygen extraction fraction were declared eligible. The positron emission tomographic images were compared to ultimate infarction defined by computed tomography performed during the chronic stage. The penumbra (operationally defined by increased oxygen extraction fraction and divided outcome despite uniformly reduced cerebral blood flow) was individually detected in 10 of the 11 patients; cerebral blood flow ranged from 7 to 17 ml/100 gm x min, consistent with that found in monkey studies. The volume of the penumbra that escaped infarction was highly correlated with neurological recovery (p < 0.04 to p < 0.0001, depending on the scale used). This longitudinal study is the first to characterize the penumbra in humans and to document one mechanism strongly influencing recovery; the surviving penumbra may offer opportunities for secondary perifocal neuronal reorganization. Therapeutic measures to prevent infarction of the penumbra (up to 16 hours in this series) may have reduced residual neurological impairment. Mapping the extent of the penumbra, according to prospective criteria, may allow one to predict each patient's potential for recovery, and to select the most appropriate candidates for therapeutic trials.
缺血性中风后的早期恢复取决于功能受损的严重缺血（即“半暗带”）组织的最终存活情况。在一系列连续26例首次发生于大脑中动脉区域中风且在18小时内接受正电子发射断层扫描研究的患者中，所有11例存活至2个月终点且氧摄取分数增加的患者被判定符合条件。将正电子发射断层扫描图像与慢性期计算机断层扫描所确定的最终梗死区域进行比较。在11例患者中的10例中分别检测到了半暗带（根据氧摄取分数增加和尽管脑血流量均一性降低但预后不同来进行操作性定义）；脑血流量范围为7至17 ml/100 gm×min，与猴子研究中的结果一致。未发生梗死的半暗带体积与神经功能恢复高度相关（根据所使用的量表，p<0.04至p<0.0001）。这项纵向研究首次对人类半暗带进行了特征描述，并记录了一种强烈影响恢复的机制；存活的半暗带可能为继发性灶周神经元重组提供机会。预防半暗带梗死的治疗措施（在本系列中可达16小时）可能会减少残留神经功能缺损。根据前瞻性标准绘制半暗带范围，可能有助于预测每位患者的恢复潜力，并为治疗试验选择最合适的候选对象。
