完全性脊髓损伤早期患者脑皮层结构变化的磁共振研究

Brain cortex structural changes in complete spinal cord injury detected by MRI

目的：观察完全性脊髓损伤（SCI）患者在损伤早期大脑皮层结构是否存在改变及其与患者感觉运动功能损伤程度的相关性.方法：2013年10月～2013年12月在北京军区总医院骨科住院的13例完全性SCI患者被纳入研究,其中男7例,女6例,年龄26.3±7.9岁（21～40岁）.同时招募健康对照15例,其中男8例,女7例,年龄25.7±5.8岁（20～38岁）.SCI患者损伤时间为64.4±20.3d（28～84d）.13例患者脊髓功能用美国脊髓损伤协会（ASIA）分级标准评定均为A级,其中ASIA运动评分为36.5±25.9（18～55）分,针刺觉评分为43.3±27.3（27～88）分,轻触觉评分为42.5±30.3（25～80）分.所有SCI患者在入院当天接受结构MRI检查.MRI扫描后的结构数据用基于体素形态学分析的方法（VBM）来分析,对比分析13例完全性SCI患者和15例年龄、性别相匹配的健康对照者大脑灰质体积改变的区域.运用Person相关性分析探讨脑皮层结构改变与患者运动感觉功能之间的关系.结果：与健康对照者相比,完全性SCI患者初级运动中枢、初级躯体感觉中枢和辅助运动区存在明显的灰质萎缩（P＜0.05）.相关性分析显示完全性SCI患者上述区域萎缩程度与患者的ASIA运动评分以及ASIA感觉评分无明显相关性（P＞0.05）.结论：在损伤早期,完全性SCI患者初级运动中枢、初级躯体感觉中枢和辅助运动区存在明显的灰质萎缩,上述区域萎缩程度与患者的ASIA评分无明显相关性.

Objectives： To investigate the brain structural changes during the early stage of complete spinal cord injury（SCI） and the relationships between these structural changes and the injury extent of patients＇ sen- sorimotor functions. Methods： From October to December 2013, 13 patients with complete SCI were included from the department of orthopedics of General Hospital of Beijing Military Region, including 7 males and 6 females with the age ranging from 21 to 40 years（average, 26.3±7.9 years）. Meanwhile, 15 healthy controls were enrolled, including 8 males and 7 females with the age ranging from 20 to 38 years（average, 25.7±5.8 years）. The mean injury time of SCI patients was 64.4±20.3 days（ranged 28-84 days）. The neurologic assess- ment was performed using the American Spinal Injury Association（ASIA） Standard Neurologie Classification of SCI. The ASIA impairment scale（AIS） and ASIA motor score were assessed. In this study, all patients have the grade of A of ASIA impairment scale, and have the total ASIA motor score 36.5±25.9（range, 18±55）, A- SIA pinprick sensory score 43.3±27.3 （range, 27-88）, ASIA light touch sensory score 42.5±30.3（range, 25-80）. All of the patients performed the MRI scan on the day of arrival. Voxel-based morphometry was used to in- vestigate the regions with gray matter volume changes. Pearson correlation analysis was used to explore the relationship between the brain structural changes and patients＇ sensorimotor function. Results： Compared with healthy controls, complete SCI patients showed significant decreased gray matter volume in the primary motor cortex, primary somatosensory cortex and supplementary motor area（P〉O.05）. In addition, there was no signifi- cant correlations between the extents of atrophy in these regions and the American Spinal Injury Associationmotor or sensory score in patients with SCI（P〉0.05）. Conclusions： At the early stage of injury, the complete SCI patients showed significant gray matter atrophy in the primary motor cortex, primary somatosensory cortex and supplementary motor area, however, the extents of atrophy in these regions were not related to the injujry extents of patients＇ sensorimotor functions.