上海交通大学学报（医学版）

›› 2013, Vol. 33 ›› Issue (5): 697-.doi: 10.3969/j.issn.1674-8115.2013.05.039

• 短篇论著 • 上一篇    下一篇

氢质子磁共振波谱在弥漫性轴索损伤评估中的临床应用

吴 剑1, 沈国良1, 牟朝辉1, 黄丹江2, 李春茂1, 黄志澄1, 应 勇1   

  1. 台州市第一人民医院 1.神经外科, 2.影像科, 台州 318020
  • 出版日期:2013-05-28 发布日期:2013-05-28
  • 作者简介:吴 剑(1979—), 男, 主治医师, 学士； 电子信箱: tyysjwk@163.com。

Clinical application of 1H-proton magnetic resonance spectroscopy in evaluation of |diffuse axonal injury

WU Jian1, SHEN Guo-liang1, MOU Chao-hui1, HUANG Dan-jiang2, LI Chun-mao1, HUANG Zhi-cheng1, YING Yong1   

  1. 1.Department of Neurosurgery, 2.Department of Radiology, the First People´s Hospital of Taizhou, Taizhou 318020, China
  • Online:2013-05-28 Published:2013-05-28

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摘要：

目的 通过氢质子2D-CSI磁共振波谱（1H-MRS）成像研究弥漫性轴索损伤(DAI)患者不同部位神经生化代谢变化及其与临床预后的关系。方法 40例DAI患者分别在伤后1、2、3和4周不同时点行1H-MRS检查，动态分析中线旁白质、基底节内囊区域、胼胝体、脑干和小脑等易出现轴索损伤区域即1H-MRS兴趣区（ROI）的神经生化代谢改变，并与15名健康志愿者（对照组）进行比较，采用直线回归分析患者1H-MRS值与伤后6个月格拉斯哥预后评分(GOS)的相关性。结果 与对照组比较，DAI患者N-乙酰天冬氨酸/总肌酸（NAA/Cr）和N-乙酰天冬氨酸/胆碱化合物（NAA/Cho）值下降，胆碱化合物/总肌酸（Cho/Cr）值升高(P<0.05)，且随伤情加重，这种变化更加明显。同一时点不同部位代谢物水平不同，同一部位不同时点代谢物水平也不同，不同部位不同时点的代谢物水平与患者预后的相关性也不同，脑干与胼胝体在受伤后第3周的代谢物水平与预后相关度最强。结论 1H-MRS检测对评估DAI患者的病情及预后有重要价值。

关键词: 弥漫性轴索损伤, 氢质子磁共振波谱, 神经生化代谢, 格拉斯哥预后评分

Abstract:

Objective To determine the neurological metabolic abnormalities in different regions by 1H-proton magnetic resonance spectroscopy (1H-MRS) and explore their relationship with the prognosis in patients with diffuse axonal injury. Methods Forty patients with diffuse axonal injury underwent 1H-MRS examination in the sensitive zones to diffuse axonal injury such as corpus callosum, brainstem, cerebellum and nasal ganglia 1 week, 2 weeks, 3 weeks and 4 weeks after injury, and the neurometabolite alterations were evaluated and compared with those of 15 healthy volunteers (control group). Linear regression analysis was used to assess the correlation between 1H-MRS value and Glasgow outcome scale (GOS) 6 months after injury. Results There was a significant decrease in NAA/Cr and NAA/Cho and increase in Cho/Cr in the sensitive zones in patients with diffuse axonal injury as compared with control group (P<0.05), and these trends tended to be more evident with the increase of injury severity. The neurometabolite alterations varied at different time points and regions. The correlation between neurometabolite alterations and outcome was also different at different time points and regions, and the correlation between neurometabolite alterations and outcome was the strongest in the corpus callosum and brainstem 3 weeks after injury. Conclusion 1H-MRS examination plays a role in the evaluation of disease condition and prediction of outcomes in patients with diffuse axonal injury.

Key words: diffuse axonal injury, 1H-proton magnetic resonance spectroscopy, neurometabolites, Glasgow outcome scale