磁共振波谱成像、事件相关电位及脑震荡后综合征问卷评分在轻度创伤性脑损伤中的应用价值研究  

Application Value of Magnetic Resonance Spectroscopy, Event Related Potential and Rivermead Post Concussion Syndrome Questionnaire Scores in Mild Traumatic Brain Injury

作　　者：陶仅德[1] 李秋雨[1] 漆强[1] 曾鹏[2] 刘晓[1] 吴贵平[2] 

机构地区：[1]东莞东华医院放射科,广东省东莞市523110 [2]东莞东华医院神经外科,广东省东莞市523110

出　　处：《中国全科医学》2017年第6期731-735,共5页Chinese General Practice

基　　金：东莞市医疗卫生科技计划一般项目(201210515046251)

摘　　要：背景轻度创伤性脑损伤(mTBI)较常见且其引发的脑震荡后综合征严重困扰着患者的生活,由于其临床表现相对主观,相关辅助检查阳性率不高,临床诊断尚存争议,因此探寻早期诊断、评估预后的有效检测手段尤为重要。目的探讨磁共振波谱成像(MRS)、事件相关电位(P300)及脑震荡后综合征问卷(RPQ)评分在mTBI中的应用价值。方法 2012年5月—2015年6月选取东莞东华医院符合纳入标准的mTBI患者30例为病例组,同期选取于本院体检健康的志愿者30例为对照组。两组分别进行MRI检查、P300检测和RPQ评分,分别测量其大脑的基底核、额叶白质、半卵圆中心、胼胝体膝部、胼胝体压部左侧及其右侧的代谢物[N-乙酰天冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)]水平,并记录病例组患侧、健侧NAA/Cr、Cho/Cr,对照组左侧、右侧NAA/Cr、Cho/Cr,记录两组P300波幅、P300潜伏期、RPQ评分。结果两组常规MRI检查均未见异常,病例组额叶白质、半卵圆中心患侧NAA峰较其健侧下降、Cho峰较其健侧升高。对照组基底核、额叶白质、半卵圆中心、胼胝体膝部、胼胝体压部左侧NAA/Cr、Cho/Cr与右侧比较,差异无统计学意义(P>0.05);病例组基底核、胼胝体膝部、胼胝体压部患侧NAA/Cr、Cho/Cr与健侧比较,差异无统计学意义(P>0.05);病例组额叶白质、半卵圆中心患侧NAA/Cr小于健侧,Cho/Cr大于健侧(P<0.05)。病例组P300波幅小于对照组,P300潜伏期、RPQ评分大于对照组(P<0.05)。病例组额叶白质、半卵圆中心患侧的NAA/Cr与P300波幅呈正相关(r=0.874,P<0.001;r=0.883,P<0.001),与P300潜伏期(r=-0.813,P<0.001;r=-0.850,P<0.001)、RPQ评分(r=-0.617,P<0.001;r=-0.627,P<0.001)均呈负相关;病例组额叶白质、半卵圆中心患侧的Cho/Cr与P300波幅均呈负相关(r=-0.862,P<0.001;r=-0.749,P<0.001),与P300潜伏期(r=0.607,P<0.001;r=0.552,P=0.002)、RPQ评分(r=0.786,P<0.001;r=0.558,P=0.001)均呈正相关。结论 MRS能从�Background It is common to see mild traumatic brain injury（mTBI）and emergence of post concussion syndrome seriously troubles the life of patients. Because of relatively subjective clinical manifestations and the not high relevant＆amp;nbsp;auxiliary examinations,its current clinical diagnosis remains controversial. It is important to explore the effective detection methods for early diagnosis and prognosis evaluation. Objective To explore the value of magnetic resonance spectroscopy （MRS）, event related potentials （ P300 ） and rivermead post concussion symptoms questionnaire （ RPQ ） score in mTBI. Methods According to the inclusion criteria,30 mTBI patients and 30 healthy volunteers after physical examination in Dongguan Tung Wash Hospital from May 2012 to June 2015 were respectively selected as case group and control group. All the subjects were performed with MRI examination,P300 detection and RPQ scores. The levels of metabolites〔 N - acetylaspartate （NAA）,creatine（Cr）,choline（Cho）〕in the left and right side of basal ganglia,white matter of frontal lobe,semioval center,genu of corpus callosum,and splenium of corporis callosum were measured respectively. NAA/ Cr and Cho/ Cr of affected side and healthy side in the case group,and NAA/ Cr and Cho/ Cr of left side and right side in the control group,amplitude and latency period of P300 and RPQ score of all subjects were recorded. Results The routine MRI examination in the two groups showed no abnormalities. In case group,NAA peak in affected side of white matter of frontal lobe and semioval center declined and Cho peak increased compared with the healthy side. There was no significant difference in NAA/ Cr and Cho/ Cr between left side and right side of basal ganglia,white matter of frontal lobe,semioval center,genu of corpus callosum,splenium of corporis callosum in control group（P ﹥ 0. 05）;there was no significant difference in NAA/ Cr and Cho/ Cr between affected side and healthy side of basal ganglia,genu of corpus callos

关 键 词：脑损伤 磁共振成像 事件相关电位 P300 脑震荡后综合征 

分 类 号：R651.1[医药卫生—外科学]