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目的 探讨脑梗死后脑梗死区及对侧大脑半球相应区域感兴趣区 (VOI)的代谢变化和高糖对各区域代谢的影响。方法 采用磁共振定域波谱技术 (MRS) ,在同一活体上分别连续测定梗死区与对照区的1H MRS。结果 梗死区胆碱 (Cho)、磷酸肌酸 /肌酸 (Pcr/Cr)、N 乙酰天门冬氨酸(NAA)强度均低于对照区 ,NAA在梗死急性期变化明显 ,加用高糖 30分钟后可见梗死区原有乳酸(Lac)信号成倍增加 (Lac/NAA 1 0 873) ,随着时间推移逐渐恢复 (Lac/NAA 0 30 13)。结论 (1)采用MRS定域谱技术可更精确、更客观地检测各VOI区代谢变化。 (2 )脑梗死区NAA、Cho、Cr均有下降 ,而NAA下降更为明显 ,非梗死半球各指标无明显变化 ,NAA可望作为MRS早期诊断脑梗死的有效指标。 (3)高糖可加剧脑梗死区的病理代谢导致Lac积聚 ,及时停用高糖可望缓解Lac积聚状态。本文客观地直接展示了高糖加剧梗死区病理代谢的全过程 ,为改进临床治疗提供了直接有力的证据。
Objective To investigate the metabolic changes of the region of interest (VOI) in the cerebral infarction area and the contralateral hemisphere after cerebral infarction and the effect of high glucose on the metabolism of each area. Methods MRS was used to determine the 1H MRS in the infarct area and the control area respectively on the same living body. Results The levels of Cho, Pcr / NAA in the infarct area were lower than those in the control area. NAA was significantly changed in the acute stage of infarction. Minutes later, the original lactic acid (Lac) signal was multiplied (Lac / NAA 1 0 873) in the infarct zone and gradually recovered with time (Lac / NAA 0 30 13). Conclusion (1) MRS localization spectroscopy can be more accurately and objectively detected in each VOI metabolic changes. (2) NAA, Cho and Cr in cerebral infarction area decreased, while NAA decreased more obviously. There was no significant change in each index in non-infarcted hemisphere. NAA could be used as an effective indicator for early diagnosis of cerebral infarction in MRS. (3) high glucose can exacerbate the pathological metabolism of cerebral infarction area leading to Lac accumulation, timely disabling high glucose is expected to ease Lac accumulation. Objectively, this article directly demonstrated that high glucose exacerbates the pathological metabolism in the infarction area and provides direct and powerful evidence for improving clinical treatment.