高场强磁共振弥散张量成像对重型创伤性脑损伤的预后评价研究

Prognostic application of the high-field magnetic resonance diffusion tensor imaging in severe traumatic brain injury

目的 研究重型创伤性脑损伤（severe traumatic brain injury,STBI）的高场强磁共振弥散张量成像（diffusion tensorimaging,DTI）检查结果,以及DTI的检查结果与STBI患者预后的关系,评价其在预后方面的预测价值.方法 选择2010年3月～2012年9月内蒙古林业总医院（内蒙古民族大学第二临床医学院）神经外科治疗的STBI患者42例（STBI组）,选取同期正常成年人20例作为正常对照组.入院后对STBI组患者行格拉斯哥昏迷评分（GCS）,评估患者病情严重性,伤情稳定后对两组进行高场强DTI检查,分析并比较两组各向异性分数（FA）值.治疗后统计STBI组患者格拉斯哥预后评分（GOS）,并分析DTI检查结果与GOS评分预后的相关性.结果 ①STBI组脑干区和胼胝体压部各FA值[（0.693±0.060）、（0.608±0.046）]均低于正常对照组[（0.898±0.078）、（0.841±0.062）],差异均有统计学意义（P＜0.05）.②STBI组患者中,GOS评分4～5分者3例,GOS评分3分者21例,GOS评分为2分者11例,GOS评分1分者7例.经Spearman直线相关分析,STBI组患者FA值与GOS评分之间成正相关关系（r=0.372,P=0.006）.结论 高场强磁共振DTI检查可以作为评估STBI患者脑损伤程度以及判断预后的依据.

Objective To evaluate the predictive role of high-field magnetic resonance diffusion tensor imaging （DTI） on the prognosis of severe traumatic brain injury （STBI） patients.Methods Clinical data of 42 patients from March 2010 to September 2012 in Inner Mongolia Forestry General Hospital （the Second Clinical Medical School of Inner Mongolia Nationalities University） were selected as STBI group; 20 cases of normal adult in the same term were chosen as normal control group.Glasgow coma scale （GCS） score was done to assess the severity of the patient＇s condition in STBI group.High-field magnetic resonance DTI scans were also performed after the patients＇ condition were stable,FA value was analyzed and compared between the two groups.GOS score was analyzed in STBI group after the treatment; the correlation between the GOS score prognosis and DTI results was analyzed.Results ①FA value of brainstem and splenium of corpus callosum in STBI group [（0.693±0.060）,（0.608±0.046）] were all lower than those in normal control group [（0.898±0.078）,（0.841±0.062）],the differences were statistically significant （P 〈 0.05）.②3 cases of GOS score 4-5 points,21 cases of GOS score 3 points,11 cases of GOS score 2 points,7 cases of GOS score 1 points were found in STBI group.The positive correlation relationship between the FA value and GOS score in STBI group according to the Spearman correlation analysis （r =0.372,P =0.006）.Conclusion The high-field magnetic resonance DTI scans is a valuable tool for the assessment of the brain damage extent and prognosis for STBI patients.