DTI在多系统萎缩(橄榄-脑桥-小脑萎缩型)诊治中应用与预后评估  

DTI on treatment application and prognosis evaluation of MSA(OPCA)

作　　者：李琳[1] 杨硕[1] 赵丹鹏[1] 刘喜灿[1] 卜淑芳[1] 贾延劼[2] 

机构地区：[1]郑州大学附属郑州中心医院老年神经内科,郑州450006 [2]郑州大学第一附属医院神经内科,郑州450002

出　　处：《医药论坛杂志》2015年第2期47-49,共3页Journal of Medical Forum

摘　　要：目的探讨利用磁共振弥散张量成像（Diffusion Tensor Imaging,DTI）评估多系统萎缩--橄榄-脑桥-小脑萎缩型（Multiple System Atropy—olive-pontine-cerebellar type,MSA-C）脑组织损害情况,从而指导临床诊治,进而对患者预后做出科学评估。方法选择年龄在40岁以上已确诊的MSA-C型患者28名;采用Berg平衡量表（Berg Balance Scale,BBS）进行平衡功能评定,BBS21∽40,通过测量桥脑、小脑蚓部、小脑半球、小脑中脚DTI的平均弥散系数值（mean diffusivity,MD）和部分各向异性（fractional anisotrophy,FA）,分为A组14人和B组14人。A组和B组均在常规治疗的基础上进行康复训练6个月;通过BBS和日常生活量表（ADL）测评,评定患者运动障碍进展及日常生活情况。结果 A组BBS和日常生活量表（ADL）无变化或下降,B组则变化明显,差异有显著性（P〈0.05,P〈0.01）。结论通过DTI定量检测MSA-C型患者脑组织损害微观结构改变,细致展示橄榄-脑桥-小脑白质纤维束分布情况,初步预测患者对于临床药物、康复治疗效果,从而提前将患者可能面临的困境告知,让其提前有所准备,提高患者的生活质量。Objective To study using MR diffusion tensor imaging（ DTI） to evaluate the brain tissue damage with multiple system atropy—olive- pontine- cerebellar type（ MSA- C）,at the same time,to guide us clinical treatment and to predict the prognosis of patients. Methods All of 28 patients were diagnosed as MSA- C and more than 40 years old.Assess the balance ability with Berg Balance Scale（ BBS）,which was between 21 and 40. After measuring mean diffusivity（ MD） and fractional anisotrophy（ FA） of pontin,cerebellar vermis,cerebellar hemispheres and middle peduncle of cerebellum,distinguish the patients into group A and group B,14 patients in each group. Comparing with healthy volunteers,no difference of MD and FA of symmetrical zone in brain tissue in group A,the MD elevating and FA decreasing of symmetrical zone in brain tissue in group B. Both group were treated with routine therapy combining with balance rehabilitation 12 weeks and visited them 1 year later,to assess their movement disturbance and dalily life with BBS and ADL.Results The BBS and ADL of group A changed little or decreased,but the group B decreased remarkably（ P〈0. 05,P〈0. 01）. Conclusion To test these patients microscopic structure of damaged brain tissue and show the spreading of white matter fibers of live- pontine- cerebellum with DTI,and predict the effects of treatment with medicine and rehabilitation primarily. At the same time,tell patients the difficulties that they faced currently and prepared early for improving life quality.

关 键 词：弥散张量成像 多系统萎缩 橄榄-脑桥-小脑萎缩型 预后 

分 类 号：R322.8[医药卫生—人体解剖和组织胚胎学]