质子磁共振波谱分析在原发性脑干损伤中的应用

~1H-proton magnetic resonance spectroscopy in the primary brain stem injury

目的通过质子磁共振波谱(1 H-proton magnetic resonance spectroscopy,1 H-MRS)研究原发性脑干损伤(primary brain stem injury,PBSI)患者局部神经异常代谢状态及其与预后的关系。方法 36例PBSI患者在伤后3h～16天行1 H-MRS检测,分析伤后神经代谢物的变化特征,并与12名健康志愿者(对照组)进行比较。采用直线回归分析患者1 H-MRS值和临床指标与伤后6个月格拉斯哥预后评分(Glasgow outcome score,GOS)的相关性。结果与对照组相比,PBSI患者桥脑腹侧NAA/Cr和NAA/Cho值下降,Cho/Cr值升高(P<0.05),且随伤情加重表现更加明显。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);损伤组NAA值的变化与GOS呈显著正相关(r=0.79,P<0.05);Cho/NAA值与GOS呈显著负相关(r=-0.65,P<0.05)。结论 PBSI患者在伤后早期进行1 H-MRS检测对评估损伤严重程度和预后有重要价值。

Objective To observe the focal neurological metabolic abnormalities and its relationship with the prognosis in patients with primary brain stem injury（PBSI） by proton magnetic resonance spectroscopy（1H-MRS）.Methods Thirty-six PBSI patients were enrolled as study group underwent 1H-MRS between 3 hours and 16 days after injury.Twelve volunteers were enrolled as control group.Linear regression analysis was used to assess the correlation between 1H-MRS value and clinical index and Glasgow outcome score（GOS） 6 months after injury.Results Compared with controls,ventral pontine NAA/Cr and NAA/Cho values decreased,and Cho/Cr value increased（P0.05）in PBSZ patient,and the difference got more obvious as injury aggravated.Patients with poor prognosis had lower NAA/Cr and NAA/Cho values than those with favourable prognosis（P0.05）.In study group,NAA and GOS was positively correlated（r=0.79,P0.05）,while Cho/NAA and GOS was negatively correlated（r=-0.65,P0.05）.Conclusions Analysis of 1H-MRS in PBSI patients at the early stage was useful in evaluating the severity of injury and prognosis.