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要旨 慢性期TIA症例における脳循環動態を明らかにする目的で,TIA症例10例および健康成人5例(control)において,133Xe吸入法を用いて,安静時ならびに5%CO2負荷時の脳血流測定を行った。脳血流量の指標として,Initial Slope Index(ISI)を用い,安静時ならびに負荷時の半球平均値meanISI,CO2反応性について検討した。安静時meanISIは,controlに比べTIA症例において,病側・健側の両半球で有意に低下していた(p<0.05)。5%CO2負荷により,TIA症例のmeanISIは,両半球で有意に増加したが,負荷時meanlSIも両半球において,controlに比べ有意に低下していた(p<0.05)。TIA症例のCO2反応性は,con—trolに比べ,両半球においてやや低下していたが,その差は有意でなかった。TIA症例において,脳血管のCO2反応性は健康成人と同程度に保たれているが,慢性的に広汎な脳乏血が存在し,この上に,microem—bolusやhemodynamic compromiseなどによる一過性の局所脳血流低下が加わり,TIAが発症すると考えられた。
To elucidate the changes in cerebral blood flow (CBF) and CO2 reactivity in patients with transient ischemic attack (TIA), 10 patients with TIA and 5 healthy adults (controls) underwent two consecutive CBF measurements (i. e. the first measurement during room air inhalation and the second measurement during 5%CO2 inhalation) .Hemispheric mean CBF was determined by each CBF measurement using 133Xenon inhalation method. CO2 reactivity was evaluated by analysing ⊿CBF ( = mean CBF during hypercapnea-mean CBF at rest) and ⊿CBF/⊿PaCO2 . The resting mean CBF values in the bilateral hemispheres (i. e. both of the affected and unaffected hemispheres) were significantly lower in TIA patients than controls (p<0.05). Inhalation of 5%CO2 significantly increased mean CBF in TIA patients bilaterally, however the mean CBF value during hypercapnea was again significantly lower in TIA patients than controls (p<0.05). CO2 reactivity in TIA patients was not significantly different from controls (p>O. 05). The result demonstrated that TIA patients have a chronic and global cerebral oligemia with normal CO2 reactivity. The chronic and global cerebral oligemia may develop a transient ischemic neurological symptom by being superimposed with local decrease of CBF.
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