飞行员脑白质高信号临床意义的研究进展

Research progress on clinical significance of white matter hyperintensities in pilots

目的 综述飞行员脑白质高信号（white matter hyperintensities,WMHs）研究进展,为影像检查有WMHs的飞行员的航空医学鉴定提供参考. 资料来源与选择 国内外有关WMHs的研究论文. 资料引用 引用国内外公开发表的文献资料42篇. 资料综合 根据现有的国内外有关WMHs的相关研究,简要概述了普通人和飞行员WMHs的特点.与普通人群相比,高空飞机（U-2）飞行员WMHs的体积大、数量多;体积增加主要在额叶、岛叶、边缘系统和颞叶区域;数量增加主要在岛叶、边缘系统和颞叶区域.飞行员WMHs更均匀地分布于大脑,并且不会随着年龄而增加.伴有中枢神经系统减压病（neurological decompression sickness,NDCS）的飞行员比不伴有NDCS的飞行员WMHs体积显著提高,尤其是岛叶的WMHs体积,但是WMHs数目增加不明显;两者WMHs的类型无显著差异. 结论 因飞行员工作环境的特殊性,其WMHs与普通人群有不同的特点与临床意义.临床航空医生应提高对WMHs的认识,根据WMHs的部位和大小以及是否对飞行工作的影响等,对飞行员进行个体化医学鉴定.

Objective To summarize the progress on the research of white matter hyperintensities （WMHs） and provide reference to make the medical assessment for the pilots with WMHs image.Literature resource and selection The related articles in this field published at home and abroad.Literature quotation Forty-two references were cited.Literature synthesis According to the present domestic and foreign related research about WMHs,the characteristics of WMHs of ordinary people and pilots were briefly reviewed.Compared with the ordinary people,the number of high-altitude U-2 pilots＇ WMHs was much more at insula,limbic system and the temporal lobe area,and the volume was bigger at frontal lobe,insula,the limbic system and the temporal lobe area.The pilots＇ WMHs are more well-distributed in the brain and will not increase with age.The volume of WMHs in the pilots with neurologic decompression sickness （NDCS） is significantly increased than those without NDCS,especially at insula.But NDCS does not result in the number of WMHs increased in pilots.The difference of WMHs types between them is not significant.Conclusions Because of the special work environment of pilots,the characteristics and clinical significance indicate difference between pilots and ordinary people.Clinical aviation doctors should improve the understanding of WMHs to make the individual medical assessment for the pilots according to the position and volume of WMHs as well as the impact to flight.