摘要
目的：探索稳定性和进展性急性缺血性卒中患者体液中谷氨酸（ Ｇｌｕ）升高的时限。方法：应用高效液相色谱分析检测１２８ 例首次发病的急性脑梗死（ Ａ Ｃ Ｉ）患者发病１～７ 日的血浆 Ｇｌｕ、脑脊液（ Ｃ Ｓ Ｆ） Ｇｌｕ 浓度的变化，并与同期检测的神经功能缺失程度（ Ｃ Ｓ Ｓ积分）、脑梗死容积（ Ｃ Ｔ Ｖ）进行相关分析。结果：１２８ 例 Ａ Ｃ Ｉ患者的平均血浆 Ｇｌｕ、 Ｃ Ｓ Ｆ Ｇｌｕ 浓度分别为（１３６２９±３２５３）ｍ ｍ ｏｌ／ Ｌ和（６４８±３２９）ｍ ｍ ｏｌ／ Ｌ，均显著高于对照组〔（１２９２０±２８１５）ｍ ｍ ｏｌ／ Ｌ和（３０９±１４８）ｍ ｍ ｏｌ／ Ｌ， Ｐ＜ ００５ 和 Ｐ＜ ０００１〕；进展性 Ａ Ｃ Ｉ组平均 Ｃ Ｓ Ｆ Ｇｌｕ 浓度为（６４７±１３２）ｍ ｍ ｏｌ／ Ｌ，极显著高于稳定性 Ａ Ｃ Ｉ组〔（５３２±１０７）ｍ ｍ ｏｌ／ Ｌ， Ｐ＜ ０００１〕；稳定性组 １～７ 日各时间点的血浆 Ｇｌｕ 浓度无显著变化，而进展性 Ａ Ｃ Ｉ组于发病 ４ 日内的血浆 Ｇｌｕ 浓度进行性升高； Ｃ Ｔ Ｖ≥１０ ｃｍ ３ 组平均 Ｃ Ｓ Ｆ Ｇｌｕ 浓度为（６７４±１３７）ｍ ｍ ｏｌ／ Ｌ，极显著高于 Ｃ Ｔ Ｖ＜ １０ ｃｍ ?
Objective:To study the pattern of glutamate (Glu) elevation in patients with stable and progressive ischemic stroke.Methods:By highperformance liquid chromatography (HPLC),Glu concentrations both in plasma and cerebral spinal fluid (CSF) were measured in 128 patients with acute cerebral infarction (ACI) on days 1 to 7 after onset and 20 control subjects.At the same time,Canadian Stroke Scale (CSS) score and cerebral infarction volume (CTV) were also obtained and analyzed.Results:Mean plasma and CSF Glu concentrations in the patients significantly elevated compared with control subjects 〔plasma Glu:(136 29± 32 53)mmol/L vs.(129 20±28 15)mmol/L, P <0 05;CSF Glu:(6 48±3 29)mmol/L vs.(3 09± 1 48)mmol/L , P <0 01〕.Mean CSF Glu concentrations in 50 patients with progressive ischemic stroke significantly increased over that in 78 patients with stable ischemic stroke 〔(6 47±1 32)mmol/L vs.(5 32± 1 07)mmol/L , P <0 001〕.Mean Glu concentrations in plasma did not show significant changes in various time points during 7 days observation period in 78 patients with stable ischemic stroke,but it was markedly increased on day 4 after onset in 50 patients with progressive ischemic stroke.Moreover,mean CSF Glu concentrations in patients with CTV≥10 cm 3 were significantly higher than those with CTV<10 cm 3 〔(6 74± 1 37)mmol/L vs.(4 24± 1 04)mmol/L , P <0 001〕.In 50 patients with progressive ischemic stroke,Glu concentration in CSF was significantly positively correlated with CTV values ( r =0 303, P <0 05).Conclusions:The sustained elevation of Glu observed in progressive stroke suggests that the window to prevent neurological deterioration may be wider.Determination of Glu concentration in CSF may serve as an available index to judge the degree of ischemic brain injury and evaluate curative effect of Glu release inhibitors.
出处
《中国危重病急救医学》
CSCD
1999年第9期545-547,共3页
Chinese Critical Care Medicine
关键词
急性
谷氨酸
治疗窗
脑梗塞
治疗
acute cerebral infarction
glutamate
therapeutic window CLC number:R743.33
Q517
Document code:A
Artical ID:10030603(1999)09054503
