瓦斯爆炸有毒气体中毒后脑部MRI表现及其与创伤后应激障碍的相关性研究  

MRI findings of the brain after gas explosion and its relationship with post-traumatic stress disorder

作　　者：赵瑞峰[1] 晋记龙[1] 李华兵[1] 李树峰[1] 田树文[1] 李海学[1] 陈雁卉[1] 王天亮[1] 马林[2] 任子敬[1] 

机构地区：[1]山西晋城煤业集团总医院放射科,048006 [2]解放军总医院放射科

出　　处：《中华放射学杂志》2008年第12期1241-1245,共5页Chinese Journal of Radiology

摘　　要：目的动态观察瓦斯爆炸伤后脑部MRI表现及其变化规律，探讨MRI表现与创伤后应激障碍（PTSD）的相关性。方法选取瓦斯爆炸后幸存者49例（A组）、爆炸当天未下井矿工40名（B组）、地面工作的矿区人员40名（C组）。对A组于瓦斯爆炸后1至3d内进行首次脑部MR检查，并进行多次复查（2、3、6个月及1年），观察病变的影像改变及其信号演变；测量3组海马、苍白球的T2信号强度值，并进行方差分析；对病变组海马、苍白球T2信号强度值及海马ADC值与PTSD的关系进行t检验。结果A组首次MRI表现：海马（33例）、苍白球（12例）、皮层（10例）及中脑（2例）呈稍长T1长T2异常信号；2个月复查：海马异常信号消失25例，遗留稍长T2信号8例；苍白球3例异常信号消失，余9例苍白球病变范围均缩小呈软化灶改变；受累皮层2例演变为软化灶，余病变恢复正常；脑干呈软化灶改变。A组与B组、C组海马及苍白球的T2信号强度值之间差异均有统计学意义（P值均〈0．01），B组与C组海马及苍白球的T2信号强度值之间差异无统计学意义（P值均〉0．05）；A组PTSD与非PTSD患者首次检查时左侧海马T2信号强度值分别为455±37、462±53，右侧为458±36、460±43；2个月时左侧海马T2信号强度值分别为438±29、424±37，右侧分别为442±31、430±32，差异均无统计学意义（t值分别为0．499、0．193、1．512、1．298，P值均〉0．05）。A组PTSD与非PTSD患者首次检查时左侧苍白球T2信号强度值分别为361±35、366±63，右侧为363±41、375±62；2个月时左侧苍白球T2信号强度值分别为341±24、337±39，右侧分别为340±26、332±35，差异亦无统计学意义（t值分别为0．350、0．826、0．503、0．907，P值均〉0．05）。A组PTSD与非PTSD患者首次检查时左侧海马ADC值分别为（8．1±1．1）×10^-4、（8．1±0．9）×10^-4mm^2／s，右侧为（8．2±1�[Abstract] Objective To investigate MR findings and dynamic changes of the brain after gas explosion, and to evaluate the relationship between MR findings and post-traumatic stress disorder （PTSD）. Methods Forty-nine survivors of a gas explosion （ group A） were examined with brain MRI within 1 to 3 days, and serial MR follow-up examinations were also performed. Forty miners not under the ground that day were assigned as group B, and 40 staff working on the ground as group C. The signal intensity values of hippoeampus and globus pallidus on T2 WI were measured in the three groups and F test was performed by using SPSS 13.0. The relationship between signal intensity values of hippocampus/globus pallidus and PTSD was explored, and the relationship between ADC values of hippocampus and PTSD was also investigated. Results In group A, slight low signal on T1WI and high signal on T2WI were detected on initial MRI in hippocampus （33 cases）, globus pallidus （12 cases）, cortex （10 cases）, and midbrain （2 cases）, respectively. On follow-up MRI at 2 months, lesions in hippocampus disappeared （25 cases） or remained slight high signal on T2WI （8 cases）, lesions in globus pallidus disappeared （3 cases, 5 sides） or showed shrinkage and encephalomalacia （9 cases）, cortical lesions resulted in encephalomalacia in 2 cases and returned normal in the others, and lesions in the midbrain showed encephalomalacia. For comparison of T2 signal intensity values in hippocampus and globus pallidus, there was significant difference between group A and group B （ P 〈 0. 01 ） , and also between group A and group C （ P 〈 0. 01 ）, but no difference was detected between group B and group C （P 〉 0.05）. In group A, the T2 signal intensities of PTSD and non- PTSD were 455 ± 37 and 462 ± 53 in the left hippocampus, and 458 - 36 and 460 ± 43 in the fight hippocampus on 1 to 3 days, and the T2 signal intensities of PTSD and non-PTSD were 438 ± 29 and 424 ±37 in the left hippoeampus, and 442 ±

关 键 词：气体中毒 脑损伤 应激障碍 创伤后 磁共振成像 

分 类 号：R686[医药卫生—骨科学]