弥散张量成像和血清生化指标在急性轻型颅脑损伤评价中的作用

The roles of diffusion tensor imaging and serum biochemical indexes in the evaluation of acute mild traumatic brain injury

目的 探讨弥散张量成像(DTI)和血清神经元特异性烯醇化酶(NSE)及S100B蛋白在急性轻型颅脑损伤(mTBI)评估中的作用。 方法 前瞻性纳入84例2013年10月至2016年1月在天津市第一中心医院神经外科住院的mTBI 患者及性别、年龄相匹配的健康志愿者70名。所有患者于受伤后7 d内行Rivermead脑震荡后综合征评分(RPQ),所有mTBI患者和50名健康志愿者行颅脑磁敏感加权成像(SWI)和DTI检查。根据SWI结果将mTBI患者分为SWI异常组和正常组,比较不同组间RPQ评分和DTI数据[各向异性分数(FA)和表观弥散系数(ADC)]的差异。同时检测34例mTBI患者和20名健康对照组血清NSE和S100B蛋白水平,比较SWI异常组、正常组及健康对照组间的差异。 结果 84例患者中,入院时SWI异常组31例,SWI正常组53例,RPQ评分中位数分别为17(1~31)分和15(2~27)分,两组差异无统计学意义(P=0.116)。出院后6个月,SWI异常组随访20例,SWI正常组随访33例,RPQ评分分别为6(1~15)分和3(1~11)分,差异无统计学意义(P=0.177)。DTI分析显示,SWI异常组FA值异常区有32处,SWI正常组有7处;SWI异常组ADC值异常区34处,SWI正常组为7处,差异均有统计学意义(P=0.001,P<0.001)。健康对照组、SWI异常组、SWI正常组血清NSE分别为(10.01±2.82)μg/L、(30.51±12.32)μg/L及(12.35±3.67)μg/L,S100B蛋白分别为(0.17±0.06)μg/L、(0.52±0.26)μg/L及(0.19±0.01)μg/L。NSE和S100B蛋白水平三组间比较,差异均有统计学意义(P=0.006,P=0.025);健康对照组与SWI正常组比较,差异均无统计学意义(均P>0.05)。 结论 头颅DTI联合血清NSE和S100B蛋白水平在精准诊治急性mTBI中具有重要的作用。

Objective To investigate the mild traumatic brain injury (mTBI) using diffusion tensor imaging (DTI)in MRI and the serum neuron specific enolase (NSE) and S100B protein expression changes.Methods A total of 84 patients with mild injury and 70 age and sex matched normal volunteers as controls were prospectively admitted to Department of Neurosurgery, Tianjin First Center Hospital between October 2013 and January 2016. All participants underwent Rivermead post-concussion symptoms questionnaire (RPQ) within 7 days of laboratory examination and evaluation. Among them, all patients with mTBI and 50 normal volunteers were included in this study to undergo MRI scanning, including susceptibility weighted imaging (SWI) and diffusion tensor imaging (DTI), within 7 days to compare the imaging characteristics. The patients were divided into 2 groups depending on SWI appearances. The mTBI group 1 consisted of those with positive findings in SWI and the mTBI group 2 consisted of the other patients. The differences in RPQ scores and DTI data, including fractional anisotropy (FA) and apparent diffusion coefficient (ADC), was analyzed between those 2 groups. The expression levels of serum NSE and S100B protein in the 34 patients with mTBI and 20 normal volunteers.Results Among the 84 patients, there were 31 patients with abnormal SWI at admission and 53 patients with normal SWI, and their median RPQ scores were 17 (1-31) and 15 (22-27) respectively. There was no significant difference between the 2 groups (P=0.116). At 6 months post discharge, 20 cases in abnormal SWI group and 33 cases in normal SWI group were followed up, and their RPQ scores were 6 (1-15) and 3 (1-11) respectively(P=0.177). DTI analysis showed that there were 32 abnormal FA areas in SWI abnormal group and 7 in SWI normal group. In addition, there were 34 ADC abnormal areas in SWI abnormal group and 7 in SWI normal group. Those differences were statistically significant (P=0.001, P<0.001). Serum NSE levels were 10.01±2.82 μg/L, 30.51±12.32 and 12.35±3.67 μg/L, S100B protein levels were 0.17±0.06 μg/L, 0.52±0.26 μg/L and 0.19 ±0.01 μg/L in healthy control group, abnormal SWI group and normal SWI group, respectively. There were significant differences in NSE and S100B protein levels among the 3 groups (P=0.006, P=0.025), while there was no significant difference between the healthy control group and the normal SWI group (all P>0.05).Conclusion The combined detection of serum NSE and S100B protein by cranial DTI may have important clinical value and significance in accurate diagnosis and treatment of acute mTBI.