作者：刘智勇，纪月岭，王海瑞，杨兮太，鲁怀康

单位：

内蒙古民族大学附属医院影像中心

Units：

Imaging Center, Affiliated Hospital of Inner Mongolia Minzu University, Tongliao 028000, China

关键词：

卒中; 缺血性脑卒中; 蒙药; 额尔敦-乌日勒; 动脉自旋标记; 磁共振成像; 治疗结果;

Keywords：

Stroke; Ischemic stroke; Mongolian drugs; Erdun-Uzhile; Arterial spin labeling; Magnetic resonance imaging; Treatment outcome

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.140

Funds：

内蒙古自治区高等学校科学研究项目（NJZY19152）

摘要：

目的 应用ASL-MRI技术评价蒙药额尔敦-乌日勒治疗缺血性脑卒中的临床效果。方法 选取2019年8月至2022年10月内蒙古民族大学附属医院收治的急性、亚急性缺血性脑卒中患者76例为研究对象，采用随机数字表法将其分为对照组和观察组，每组38例。对照组患者接受常规治疗，主要为静脉溶栓、机械取栓或球囊成形术+支架植入术，以进行脑血运重建；观察组患者在对照组基础上接受蒙药额尔敦-乌日勒治疗，20 d为1个疗程，两组患者均治疗1个疗程。比较两组患者治疗前、治疗20 d动脉自旋标记(ASL)、动态对比增强(DCE)序列检查指标[容积转运常数(Ktrans)、组织间隙-血浆速率常数(Kep)、细胞外间隙容积分数(Ve)、血浆容积分数(Vp)]及脑血流量(CBF)指标(CBF梗死侧、CBF健侧和ΔCBF)、美国国立卫生研究院卒中量表(NIHSS)评分、蒙医症候积分。结果 治疗20 d，两组Ktrans、Ve、Vp分别低于本组治疗前，Kep分别高于本组治疗前，且观察组Ktrans、Ve、Vp低于对照组，Kep高于对照组(P<0.05)。治疗20 d，两组CBF梗死侧分别高于本组治疗前，CBF健侧、ΔCBF分别低于本组治疗前，且观察组CBF梗死侧高于对照组，CBF健侧、ΔCBF低于对照组(P<0.05)。治疗20 d，两组NIHSS评分、蒙医症候积分分别低于本组治疗前，且观察组低于对照组(P<0.05)。结论 蒙药额尔敦-乌日勒可有效改善缺血性脑卒中患者血脑屏障、脑血流灌注，减轻患者神经功能缺损程度、临床症状；而ASL-MRI技术可用于评估接受蒙药额尔敦-乌日勒治疗的缺血性脑卒中患者的血脑屏障、脑血流灌注改善情况。

Abstract：

Objective To evaluate the clinical effect of Mongolian medicine Erdun-Wurile in the treatment of patients with ischemic stroke by ASL-MRI technology. Methods A total of 76 patients with acute and subacute ischemic stroke admitted to Affiliated Hospital of Inner Mongolia Minzu University from August 2019 to October 2022 were selected and divided into control group and observation group according to the random number table method, with 38 cases in each group. Patients in the control group received routine treatment, mainly intravenous thrombolysis, mechanical thrombectomy or balloon angioplasty+stent implantation for cerebral revascularization; patients in the observation group were treated with Mongolian medicine Erdun-Wurile on the basis of the control group, 20 d was a course of treatment, and both groups were treated for 1 course of treatment. Arterial spin labeling (ASL) , dynamic contrast enhancement (DCE) sequence examination indexes [volume transfer constant (Ktrans) , tissue gap-plasma rate constant (Kep) , extracellular space volume fraction (Ve) , plasma volume fraction (Vp) ] and cerebral blood flow (CBF) indexes (CBFinfarct side, CBFhealthy side and ΔCBF) , National Institutes of Health Stroke Scale (NIHSS) score and Mongolian medicine symptom score were compared between the two groups before treatment and at 20 days of treatment. Results At 20 days of treatment, Ktrans, Ve and Vp in the two groups were lower than those before treatment, Kep was higher than that before treatment, respectively, and Ktrans, Ve and Vp in the observation group were lower than those in the control group, Kep was higher than that in the control group (P < 0.05) . At 20 days of treatment, CBFinfarction side in the two groups was higher than that before treatment, CBFhealthy side and ΔCBF were lower than those before treatment, respectively, CBFinfarction side in the observation group was higher than that in the control group, CBFhealthy side and ΔCBF were lower than those in the control group (P < 0.05) . At 20 days of treatment, the NIHSS score and Mongolian medicine symptom score of the two groups were lower than those before treatment, respectively, and those in the observation group were lower than those in the control group (P < 0.05) . Conclusion Mongolian medicine Erdun-Wurile can effectively improve the blood-brain barrier and cerebral blood perfusion in patients with ischemic stroke, and reduce the degree of neurological deficit and clinical symptoms. ASL-MRI technology can be used to evaluate the improvement of blood-brain barrier and cerebral blood perfusion in patients with ischemic stroke treated with Mongolian medicine Erdun-Wurile.

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