摘要目的:探讨远隔缺血适应（remote ischemic conditioning, RIC）对急性缺血性卒中（acute ischemic stroke, AIS）患者脑灌注以及功能转归的影响。方法:前瞻性纳入2023年11月至2024年7月徐州医科大学第二附属医院神经内科收治的AIS患者，在发病48 h内随机分为RIC组和对照组。对照组按照现行诊治指南进行治疗，RIC组在此基础上进行RIC。在入院时利用三维伪连续动脉自旋标记（three-dimensional pseudo-continuous arterial spin labeling, 3D-pCASL）灌注成像技术测定脑血流量，计算校正后脑血流量（corrected cerebral blood flow, cCBF）分别<20和<30 ml/(100 g·min)的低灌注脑区体积，然后在入院第10天再次进行3D-pCASL灌注成像。主要转归指标为发病后90 d时应用改良Rankin量表评估的功能转归，0~1分定义为转归极好，0~2分定义为转归良好，>2分定义为转归不良。次要转归指标包括发病后14 d时美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分及其较基线的变化、脑灌注参数及其变化、早期神经功能恶化（early neurological deterioration, END）、出血性转化（hemorrhagic transformation, HT）以及RIC的不良反应。结果:最终完成试验及随访48例，32例（66.7%）为男性，年龄（67.60±7.37）岁，中位基线NIHSS评分3分（四分位数间距2~5分）；病因学分型：15例（31.3%）为大动脉粥样硬化，28例（58.3%）为小血管闭塞，5例（10.4%）为其他病因。31例（64.6%）为前循环卒中。48例患者中，RIC组28例，对照组20例。RIC组发病至RIC时间为（21.89±16.17）h。RIC组人口统计学和基线资料与对照组差异均无统计学意义（ P均>0.05）。RIC组90 d时转归极好（78.6%对50.0%； P=0.038）和转归良好（89.3%对60.0%； P=0.042）的患者比例均显著高于对照组，14 d时NIHSS评分及变化也显著优于对照组（ P均<0.05）。此外，RIC组治疗后cCBF<20及<30 ml/(100 g·min)的低灌注区域体积均较基线时缩小，而对照组则稍增大，两组差异均有统计学意义（ P<0.05）。RIC组END和HT发生率与对照组差异无统计学意义（ P均>0.05）。多变量 logistic回归分析显示，RIC是90 d时转归良好（优势比9.182，95%置信区间1.579~53.401； P=0.014）和转归极好（优势比9.982，95%置信区间1.257~79.230； P=0.030）的独立保护因素。RIC组未出现严重不良反应。 结论:RIC可缩小AIS患者脑组织低灌注区域体积，改善神经功能和临床转归，且无严重不良反应。

abstractsObjective:To investigate the effect of remote ischemic conditioning (RIC) on cerebral perfusion and functional outcome in patients with acute ischemic stroke (AIS).Methods:Patients with AIS admitted to the Department of Neurology, the Second Affiliated Hospital of Xuzhou Medical University from November 2023 to July 2024 were included prospectively. They were randomly divided into RIC group and control group within 48 hours of onset. The control group received treatment according to the current treatment guidelines, while the RIC group received RIC based on this. At admission, three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL) perfusion imaging technology was used to measure the cerebral blood flow and calculate low perfusion regions volume with corrected cerebral blood flow (cCBF) <20 and <30 ml/(100 g·min), respectively; and then 3D-pCASL perfusion imaging was performed again on the 10 th day of admission. The main outcome measure was the functional outcome evaluated using the modified Rankin Scale at 90 days after onset. 0-1 were defined as excellent outcome, 0-2 were defined as good outcome, and >2 was defined as poor outcome. Secondary outcome measures included the National Institutes of Health Stroke Scale (NIHSS) score at 14 days after onset and their changes from baseline, cerebral perfusion parameters and their changes, early neurological deterioration (END), hemorrhagic transformation (HT), and adverse reactions of RIC. Results:A total of 48 patients completed the test and follow-up, of which 32 patients (66.7%) were male, aged 67.60±7.37 years. The median baseline NIHSS score was 3 (interquartile range, 2-5). Etiological classification: 15 patients (31.3%) were large artery atherosclerosis, 28 (58.3%) were small vessel occlusion and 5 (10.4%) were other causes. Thirty-one patients (64.6%) were anterior circulation stroke. Among the 48 patients, there were 28 in the RIC group and 20 in the control group. The time from onset to RIC in the RIC group was 21.89±16.17 hours. There was no significant difference in demographic and baseline data between the RIC group and the control group (all P>0.05). The proportion of patients with excellent outcome (78.6% vs. 50.0%; P=0.038) and good outcome (89.3% vs. 60.0%; P=0.042) in the RIC group at 90 days were significantly higher than those in the control group. The NIHSS score and changes at 14 days were also significantly better than those in the control group (all P<0.05). In addition, the volume of low perfusion region with cCBF <20 and <30 ml/ (100 g·min) in the RIC group after treatment decreased compared to the baseline, while the control group slightly enlarged, and the difference between the two groups was statistically significant ( P<0.05). There was no significant difference in the incidence of END and HT between the RIC group and the control group (all P>0.05). Multivariate logistic regression analysis showed that RIC was an independent protective factor for good outcome (odds ratio 9.182, 95% confidence interval 1.579-53.401; P=0.014) and excellent outcome (odds ratio 9.982, 95% confidence interval 1.257-79.230; P=0.030) at 90 days. There were no serious adverse reactions observed in the RIC group. Conclusion:RIC can reduce the volume of low perfusion region in patients with AIS, improve neurological function and clinical outcome, and has no serious adverse reactions.