弥漫性轴索损伤早期质子磁共振波谱研究

Study of diffuse axonal injury at early stage using proton magnetic resonance spectroscopy

目的通过质子磁共振波谱(1H-MRS)研究弥漫性轴索损伤(DAI)早期患者胼胝体压部局部异常神经代谢状态及其与预后的关系。方法在伤后2～14d,对21例DAI患者胼胝体压部行1H-MRS检测,分析伤后神经代谢物变化特征,并与10名健康志愿者(对照组)进行比较。对DAI患者1H-MRS值和临床指标与伤后6个月格拉斯哥昏迷评分(GOS)的相关性进行Logistic回归分析。结果与对照组相比,DAI患者胼胝体压部NAA/Cr和NAA/Cho值下降,Cho/Cr值升高(P<0.05),且随伤情加重更加明显。预后不良患者的NAA/Cr和NAA/Cho值低于预后良好的患者(P<0.05);NAA/Cho、NAA/Cr、Cho/Cr值预测预后的准确率为89%,与GOS结合后为94%。结论DAI患者在伤后早期进行胼胝体压部1H-MRS检测,对评估损伤严重程度和预后有重要价值。

Objective To investigate the early alterations of neurometabolites in the splenium of corpus callosum by proton magnetic resonance spectroscopy （1H-MRS） in patients with diffuse axonal injury （DAI） at early stage and their prognostic value. Methods Twenty-one patients with DAI underwent 1H-MRS examination in the splenium of corpus callosum 2 to 14 d after injury, the neurometabolite alterations were evaluated and compared with those of 10 healthy subjects （normal controls）. Logistic regression analysis was performed to explore the correlation among neurometabolite alterations, clinical indexes and Glasgow outcome scale （GOS） six months after injury. Results There was a significant decrease in NAA/Cr and NAA/Cho and increase in Cho/Cr in the splenium of corpus callosum in patients with DAI as compared with control group （P〈0.05）, and these trends tended to be more evident with the increase of injury severity. NAA/Cr and NAA/Cho in patients with poor outcomes were lower than those in patients with good outcomes （P〈0.05）. NAA/Cr, NAA/Cho and Cho/Cr predicted long-term outcome with 89% accuracy, and the combination with GOS provided the predictive accuracy of 94%. Conclusion 1H-MRS examination in the splenium of corpus callosum at early stage of DAI can depict brain injury severity, and is useful in predicting outcomes.