末梢静脈血漿cyclic AMPによる脳梗塞障害度の早期評価

EARLY ESTIMATION OF EXTENT OF THE LESION IN CEREBRAL INFARCTION BY MEANS OF CYCLIC AMP CONCENTRATION IN PERIPHERAL VENOUS PLASMA

I．はじめに

　末梢静脈血漿（以下PVPと略す）におけるcyclicAMP濃度の経時変化が，脳血管障害の病型によつて異なり^19,20），脳梗塞では，この変化が脳シンチグラム上の異常範囲と関連のある事を，我々はすでに示唆した^20,21）。

　この論文では，脳梗塞患者のPVPにおけるcyclicAMP濃度の経時変化と，脳シンチグラム上の異常範囲との相関を検討し，cyclic AMPの濃度が変動するメカニズムについても考察を加える。

Subjects consisted of fifteen patients with cerebralhemispheric infarction who were admitted to thehospital within three days after the onset. Ante-cubital venous blood was sampled in the presenceof 0.5 M EDTA. Plasma was obtained by centri-fugation and was analyzed for cyclic AMP applyinga competitive protein binding method without anypretreatment. Brain scintigraphy was performedusing ^99mTc pertechnetate 12-19 days after theonset, except for three patients who were investi-gated 22-36 days after the onset. The size of ab-normal uptake of isotope was expressed as percentto the cross-sectional area of the intracranial spacein the lateral and the frontal (anterior or posterior)views.

1) In three patients with mild dysarthria, hemi-paresis and no disturbance of consciousness, con-centration of cyclic AMP in the peripheral venousplasma (PVP) remained in the normal range (8-18picomoles/ml) throughout the observation for 15days. This group showed no abnormal isotopeuptake in scintigrams.

2) Patients with any disturbance of consciousnessand apparent neurological deficits were divided intotwo groups according to the nature of time coursesof cyclic AMP concentration. In one group cyclicAMP concentration in PVP decreased to subnormalrange within several days after the onset, and inthe other group it remained in the normal range.

3) In the former group (4 patients), the size ofthe region of abnormal isotope uptake in scintigramswas 5-26% and 8-16% of the cross-sectional areaof the intracranial space in the lateral and in thefrontal views, respectively.

4) In the latter group (7 patients) the size ofthe lesion was over 24% and 16% in the lateraland in the frontal views, respectively. In thisgroup there was an exceptional patient who had asmall lesion. However, it was located in the basalganglionic region and neurological deficit wassevere.

5) With the time course of the level of cyclicAMP in PVP, it is probable that we can estimatethe extent of the lesion within several days afterthe onset of cerebral hemispheric infarction, whereasit usually takes more than a week by means ofbrain scintigraphy.