心肺复苏成功患者脑灰质体积和功能改变的初步研究

A pilot study of gray matter volume and function changes in patients after cardiopulmonary resuscitation

目的应用头颅磁共振成像(magnetic resonance imaging,MRI)相关技术探讨心肺复苏(cardiopulmonary resuscitation,CPR)成功患者相关脑区的结构和功能改变。方法采用单中心、观察性、横断面研究设计,连续收集2020年7月至2021年7月南京医科大学第一附属医院急诊科CPR后神经功能预后良好患者,于住院期间行头颅MRI检查。同时,纳入年龄、性别匹配的健康对照(healthy control,HC)组。收集研究对象人口学和相关临床资料,采用改良Rankin量表(modified Rankin Scale,mRS)评估患者实施MRI检查时神经功能缺损情况,采用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)评价认知功能。采用基于体素的形态学测量(voxel-based morphometry,VBM)和分数低频振幅(fractional amplitude of low-frequency fluctuation,fALFF)方法进行分析。数据预处理完成后,比较病例组与HC组之间大脑灰质体积(gray matter volume,GMV)及fALFF值的差异,并获得有差异脑区信息。同时分析病例组差异脑区影像参数与临床指标之间的相关性。结果本研究入组患者13例,HC组13例。病例组实施MRI检查时mRS评分为3分者1例,2分者3例,1分者5例。病例组MoCA评分显著低于HC组(P<0.001)。与HC组相比,病例组右侧额下回、颞上回,左侧颞上回、颞横回GMV明显减小;病例组左侧中央后回、中央前回fALFF值明显减低,而右侧壳核fALFF值明显增加(高斯随机场方法校正,体素水平P<0.001,团簇水平P<0.05)。此外,病例组右侧壳核的fALFF值与MoCA评分呈显著负相关(r=-0.710,P=0.021)。结论CPR患者可出现部分脑区灰质体积和神经元自发活动改变,VBM和fALFF方法可用于客观评价CPR成功患者脑功能活动受损情况。

Objective To explore the structural and functional alterations of related brain regions in patients after cardiopulmonary resuscitation(CPR)by brain magnetic resonance imaging(MRI).Methods A single-center,observational,cross-sectional study design was used.Patients who had brain MRI scans during hospitalization between July 2020 and July 2021 in Emergency Department of the First Affiliated Hospital of Nanjing Medical University and had good neurologic outcomes were consecutive enrolled in this study.The healthy control(HC)group consisted of age-and sex-matched volunteers.The demographic and clinical data were recorded.The modified Rankin Scale(mRS)was used to check the recovery and degree of continued disabilities when patients performed MRI.Montreal cognitive assessment(MoCA)was used to assess cognitive functions.The analyses of voxel-based morphometry(VBM)and fractional amplitude of low-frequency fluctuation(fALFF)were conducted.After data preprocessing,comparison of gray matter volume(GMV)and fALFF values between the case group and HC group were carried out,and the information of different brain regions was obtained.Partial correlation analyses were performed to evaluate the correlation between the image parameters of different clusters and clinical parameters.Results Totally 13 patients were enrolled in this study and 13 were in the HC group.All patients achieved good neurologic outcome;mRS was 3 in 1 case,2 in 3 cases,and 1 in 5 cases during MEI examination.The case group showed significantly lower MoCA score compared with the HC group(P<0.001).There were significantly decreased GMVs in the right inferior frontal gyrus,superior temporal gyrus,left superior temporal gyrus,and transverse temporal gyrus in the case group.The patients showed significantly decreased fALFF values in the left postcentral gyrus and precentral gyrus,while increased fALFF values in the right putamen than the HC group(voxel-level P<0.001 and cluster-level P<0.05 with GRF correction).In addition,mean fALFF value in the right putamen was negatively correlated with MoCA score in the case group(r=-0.710,P=0.021).Conclusions Patients after CPR may have GMVs and neuronal spontaneous activity changes in some brain regions,and VBM and fALFF methods can be used to objectively evaluate the impaired brain functional activity in patients after successful CPR.