氢质子磁共振波谱在儿童创伤性颅脑损伤的应用

Application of proton magnetic resonance spectroscopy in pediatric traumatic brain injury

目的探讨氢质子磁共振波谱(1H-MRS)分析对儿童创伤性颅脑损伤(TBI)受伤程度及预后的临床价值。方法对20例儿童TBI病人(TBI组)和10例正常儿童志愿者(正常对照组)进行1H-MRS检查,观察两组病侧与对侧N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)及NAA/Cr、NAA/Cho、Cho/Cr比值的变化,分析这些指标与GCS及GOS评分的相关性。结果与正常对照组比较,TBI组NAA/Cho、NAA/Cr比值明显下降(P<0.05),而Cho/Cr比值明显升高(P<0.05);TBI组出现Lac峰1例,最终死亡。而NAA/Cr、NAA/Cho比值变化与GCS评分呈负相关(r=-0.59,P<0.05),与GOS呈正相关(r=0.63,P<0.05);TBI组Cho/Cr比值与GCS评分呈正相关(r=0.57,P<0.05),与GOS评分呈负相关(r=-0.69,P<0.05)。结论1H-MRS对判断颅脑损伤的受伤程度及预后有重要参考价值。

Objective To investigate the clinical value of proton magnetic resonance spectroscopy （IH-MRS） in evaluation of injury severity and prognosis of traumatic brain injury （TBI） in pediatric patients. Methods Twenty pediatric patients with TBI （TBI group） and 10 normal child volunteers （normal control group） were examined by ^1H-MRS. The changes of N-acetylasparate （NAA）, choline （Cho）, creatine （Cr）, lactate （Lac）, NAA/Cr, NAA/Cho, Cho/Cr of the patients in two groups were observed and the correlations of these indicators with Glasgow coma scale （GCS） and Glasgow outcome scale （GOS） were analyzed respectively. Results Compared with the normal control group, NAA/Cho and NAA/Cr values of TBI group decreased more significantly （P〈0.05）, while the Cho/Cr values increased more significantly （P〈0.05）. The patient with elevation of Lac levels occurred in 1 case in TBI group and finally died. The changes of NAA/Cr and NAA/Cho values were negatively correlated to GCS （r=--0.59, P〈0.05）, and were positively correlated to GOS （r=0.63, P〈0.05） in TBI group. While the Cho/Cr value was positively correlated to GCS （r=0.57, P〈0.05）, and were negatively correlated to GOS （r=-0.69, P〈0.05）. Conclusions ^1H-MRS has important value for evaluating the injury severity and prognosis in pediatric patients with TBI.