应用静息态功能磁共振评价高压氧治疗对改善创伤性颅脑损伤患者执行功能的作用

Resting state function magnetic resonance imaging study on the effect of hyperbaric oxygen on the improvement of executive function of the patients with traumatic brain injury

目的应用静息态功能磁共振(resting state function magnetic resonance imaging,rs-fMRI)观察高压氧治疗(hyperbaric oxygen therapy,HBOT)对改善创伤性颅脑损伤(traumatic brain injury,TBI)患者执行功能(executive function,EF)的作用。方法选取50例TBI后EF障碍患者,按照数字表法随机分为HBO组(n=25)和对照组(n=25),对照组接受常规基础治疗及EF康复训练,HBO组在对照组治疗的基础上加用HBO治疗,HBOT压力0.2 MPa,105 min/次,1次/d,5 d/周,共20次。所有受试者在治疗前后均应用画钟测验、中文版Stroop色词测验、韦氏成人智力量表相似性评分测验EF,同时采用rs-fMRI技术结合ReHo、ALFF分析方法,观察HBOT对TBI患者的大脑各区域代谢活动的强度、局部脑区神经元细胞同步性以及协调性改变情况,分析影像学数据与神经心理学量表评估结果的相关性。结果干预后2组间比较,HBO组Stroop-A耗时、Stroop-C耗时与正确阅读数及干扰效应评分改善程度明显优于对照组,差异有统计学意义(P<0.05)。不同干预后,2组TBI患者共同脑区在顶上小叶ALFF值差异有统计学意义(P<0.05)。相关性分析发现,HBO组差异脑区顶上小叶与干扰时间呈正相关(P<0.05)。HBO组差异脑区额中回与卡片A的正确阅读数呈正相关(P<0.05)。结论EF康复训练、HBO联合EF康复训练均能不同程度地改善TBI患者的EF;HBO联合EF康复训练对改善TBI患者的EF效果更好;HBOT改善TBI患者EF可能是通过调节额中回、顶上小叶脑区的自发活动及局部一致性而实现的。

Objective To observe the effect of hyperbaric oxygen therapy (HBOT) on the improvement of executive function of the patients with traumatic brain injury (TBI) by using resting state functional magnetic resonance (rs-fMRI). Methods Fifty patients with executive disorder after traumatic brain injury were rando mly divided into the HBO group (n=25) and the control group (n=25). The patients of the control group received routine treatment and executive function rehabilitation training, while the patients of the HBO group were supplemented with HBOT in addition to the treatment received by the control group. The applied HBO pressure was 2.0 MPa, one session a day with a duration of 105 minutes, five days a week, for a total of 20 sessions. Both before and after treatment, all the subjects received executive function assessment and rs-fMRI examination by using the drawing of clock test, the Chinese version Stroop color word test and the Wechsler adult intelligence scale similarity subtest. In the study, we closely observed the effects of HBOT on the intensity of metabolic activities in the brain, changes in neuron cell synchronization and coordination in TBI patients through the approach of rs-fMRI technique combined with ReHo and ALFF analysis methods. At the same time, the correlation between imaging data and neuropsychological assessment results was also analyzed in the study. Results (1) After intervention, Stroop-A time-consumption and Stroop-C time-consumption, correct reading scores, as well as interference scores of the HBO group were all significantly better than those of the control group, and statistical significance could be found when comparisons were made between the 2 groups (P<0.05).(2) Following intervention with different methods, obvious differences in the ALFF value of superior parietal lobe in the common brain regions of the TBI patients in the 2 groups could be seen, with statistical significance (P<0.05). Correlation analysis revealed that there was a positive correlation between the superior parietal lobe and interference time in the HBO group (P<0.05).(3) There was also a positive correlation between correct readings of Stroop-A in the middle frontal gyrus of the HBO group (P<0.05). Conclusion Executive function rehabilitation training, HBO therapy combined with executive function rehabilitation training could improve the executive function of TBI patients to various degrees. HBO therapy combined with executive function rehabilitation training was more beneficial to further improvement of executive function in patients with TBI. The improvement of executive function in TBI patients by HBO therapy might be achieved through the regulation of spontaneous activity and regional homogeneity of neurons in the middle frontal gyrus, and superior parietal lobe.