脑桥梗死后相关神经纤维继发性损害的DTI研究及其意义  

Diffusion tensor imaging of the secondary degeneration of neural fibers outside the infarct foci after cerebral infarction and its impacts on neurological recovery

作　　者：梁志坚[1] 刘斯润[2] 曾进胜[1] 凌雪英[2] 王芳[1] 凌莉[1] 侯清华[1] 邢世会[1] 余剑[1] 范玉华[1] 

机构地区：[1]中山大学附属第一医院神经内科,广州510080 [2]暨南大学附属第一医院影像中心

出　　处：《中国神经精神疾病杂志》2008年第3期139-144,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：教育部高等学校优秀青年教师教学科研奖励计划资助项目(TRAPOYT,2002年);国家自然科学基金资助项目(编号:39940012,30271485);美国CMB基金资助项目(编号:00-730);卫生部临床学科重点项目基金资助项目(2004年);广东省自然科学基金资助项目(编号:990065,21906);广东省医药卫生科研基金资助项目(编号:B1999035,B2002024,B2003031);广东省博士基金资助项目(编号:984225);广东省自然科学基金团队项目(2000年);广东省自然科学基金攻关项目(编号:B30303,2003B30301);中山大学附属第一医院-生命科学院联合科研项目(2006年)

摘　　要：目的本研究应用弥散张量成像(diffusion tensor imaging,DTI)前瞻性观察局灶性脑桥梗死后继发神经纤维顺行性、逆行性变性的动态发展过程,探讨其对患者神经功能恢复的影响。方法选择单侧脑桥基底部梗死患者14例,以及年龄性别相匹配的健康志愿者14名作对照组。患者分别在发病第1周、第4周和第12周进行DTI检测,对照组只做1次DTI检查。测量脑桥(患者梗死灶所在水平)及近、远端锥体束、双侧小脑中脚的MD和FA值。在每次DTI检测之前进行NIHSS、FMS和BI评分。结果与对照组比较,患者梗死灶及其同侧近、远端锥体束纤维、双侧小脑中脚神经纤维的FA值在各个时间点均明显减少(P<0.01);梗死灶的MD在第1周时下降,在第4周及第12周则升高(P<0.01);患者梗死灶同侧近、远端锥体束纤维以及双侧小脑中脚神经纤维的MD在各个时间点均无统计学差别(P>0.05)。患者梗死灶同侧近、远端锥体束纤维以及双侧小脑中脚神经纤维的FA值,从第1周至12周随时间延长而逐渐减少(P<0.01),MD却无明显变化(P>0.05)。在观察期间,梗死灶同侧近、远端锥体束纤维以及双侧小脑中脚神经纤维的FA值减少的百分数的绝对值与同期NIHSS及FMS变化的百分数的绝对值呈负相关(P<0.05),与BI无明显相关(P>0.05)。结论局灶性脑桥梗死后,可以引起与之发生联系的神经纤维发生顺行性及逆行性继发性变性,这种神经纤维的继发性变性至少在发病后12周内逐渐进展,并可能会延缓患者神经功能的恢复。Objective To investigate the time course of anterograde and retrograde degeneration in fiber tract through the primary lesion in patients with a focal pontine basis infarct, and to explore its impact on neurological recovery. Methods Fourteen patients with a recent unilateral pontine basis infarct underwent DTI and evaluation with NIHSS, FMS and BI at 1^st week （W1） , 4^th week （W4） and 12^th week （W12） respectively. In addition, the degree of limbs motor ataxia of patients was assessed with the department Ⅱ of International cooperative Ataxia Rating Scale （ ICARS Ⅱ ） on W12. Four- teenth age and gender matched volunteers underwent DTI one time as controls. MD and FA were measured at pons （ primary lesion） , the proximal portion of pyramidal tract at cerebral peduncle, internal capsule and centrum semiovale levels, the distal portion of pyramidal tract at medulla level and middle cerebellar peduncle. A liner regression for each patient was established to explore the association between the time course of clinical scores and DTI quantitative data obtained at Wl, W4 and W12. Spearman correlation analysis was used to assess the associations between the absolute value of percent change [ （ （ W12 - W1 ） / W1 ） × 100% ] of FA values and of clinical scores including NIHSS, FMS and BI, and the correlations between the absolute value of percent change [ （ （ W12 - W1 ） / W1 ） × 100% ] of FA values and ICARS Ⅱ. Results Compared with the controls, the FA values of infarct site, the ipsilateral proximal and distal portion of pyramidal tract and bilateral of middle cerebellar peduncle in patients significantly decreased at W1, W4 and W12 （P 〈 0. 01 respectively）. The MD of infarct site decreased at W1, increased at W4 and W12 （P 〈0. 01 respectively）, whereas the MD of the ipsilateral proximal and distal portion of pyramidal tract and bilateral of middle cerebellar peduncle in patients were not significantly different at any time point （P 〉 0.05, respectively）. The a

关 键 词：脑梗死 继发性损害 弥散张量成像 部分各向异性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]