急性一氧化碳中毒性脑病的磁共振波谱学研究

Study on magnetic resonance spectroscopy of encephalopathy after acute carbon monoxide poisoning

目的观察急性一氧化碳中毒性脑病患者的磁共振波谱(MRS)表现,分析MRS对其预后的评估作用。方法选取2017年3月～2018年3月我院收治的14例急性一氧化碳中毒性脑病患者为观察组,并以同期无任何中枢神经系统病变的14例患者为对照组。两组分别给予MRS检查,经统计学处理比较其脑内代谢产物表达[N-乙醇天门冬氨酸(NAA)、含胆碱代谢物(Cho)、肌酸/磷酸肌酸(Cr)、乳酸(Lac)]。结果观察组患者基底节的NAA表达明显低于对照组,其基底节的Cho表达明显高于对照组,差异有统计学意义(P<0.05)。观察组患者基底节的NAA/Cr、Cho/NAA比值明显低于对照组,其基底节的Cho/Cr比值明显高于对照组,差异有统计学意义(P<0.05)。两组患者余脑实质的各项脑内代谢物产物表达比较,差异无统计学意义(P>0.05)。结论若有一氧化碳中毒患者波谱示Cho峰升高、NAA峰减低、NAA/Cr比值降低、Cho/Cr比值升高,考虑发生迟发性脑病的可能性大,其比值异常程度越高预测病情越严重,并且首发异常部位为基底节。

Objective To observe the magnetic resonance spectroscopy （MRS） findings of encephalopathy after acutecarbon monoxide poisoning and analyze the prognostic role of MRS. Methods A total of 14 patients with acute carbonmonoxide poisoning encephalopathy admitted to our hospital from March 2017 to March 2018 were selected as the observation group, and 14 patients without central nervous system lesions at the same period were selected as the controlgroup. MRS was performed in both groups, and the expression of metabolites in the brain （N-acetylaspartate [NAA], Choline-containing metabolite [Cho], Creatine/Creatine phosphate [Cr], Lacticacid [Lac]） was compared by statistical analysis.Results The expression of NAA in the basal ganglia in the observation group was significantly lower than that in thecontrol group, the expression of Cho in the basal ganglia was significantly higher than that in the control group, and thedifferences were statistically significant （P〈0.05）. The ratio of NAA/Cr and Cho/NAA of the basal ganglia in the observation group were significantly lower than those in the control group, the ratio of Cho/Cr of the basal ganglia was significantly higher than that in the control group, and the differences were statistically significant （P〈0.05）. There was nosignificant difference in the expression of metabolites in the brains of the remaining brains between the two groups （P〉0.05）. Conclusion If the spectrum of patients with carbon monoxide poisoning shows that the peak of Cho increases andthe ratio of NAA/Cr decreases, the ratio of Cho/Cr increases, the possibility of delayed encephalopathy can be considered. The higher the degree of abnormal ratio is, the more serious the disease is, and the basal ganglia are the first abnormal part.