弥散张量成像在中、重型弥漫性轴索损伤患者预后评估中的价值  

Application of diffusion tensor imaging in prognosis evaluation in patients with moderate and severe diffuse axonal injury

作　　者：刘兴宇 崔建忠 王余 张晓飞 田宝刚 王树伟 刘爱军 王海波 洪军 

机构地区：[1]唐山市工人医院神经外科,河北省颅脑创伤研究所,河北省唐山市063000 [2]唐山市工人医院放射科,河北省颅脑创伤研究所,河北省唐山市063000

出　　处：《中华创伤杂志》2018年第1期30-34,共5页Chinese Journal of Trauma

基　　金：2013年河北省引进留学人员资助项目（2013-140）

摘　　要：目的探讨弥散张量成像（DTI）在中、重型弥漫性轴索损伤（DAI）患者预后评估中的应用价值。方法采用前瞻性队列研究分析2013年6月-2015年12月收治的35例中、重型DAI患者（研究组）临床资料，其中男21例，女14例；年龄（55．1±11．6）岁。格拉斯哥昏迷评分（GCS）为（8．2±2．9）分。中型DAI20例，重型DAI15例。另外选取15例健康人作为对照组。利用DTI技术检测患者胼胝体压部、丘脑、脑干部位感兴趣区各向异性（FA）值。采用格拉斯哥预后评分（GOS）评定患者伤后6个月预后。比较研究组入院时与对照组各感兴趣区FA值差异及不同损伤程度患者人院与伤后6个月时FA值差异，分析人院时各感兴趣区FA值与DAI患者预后的关系。结果研究组胼胝体压部、丘脑、脑干部位FA值均低于对照组（P〈0．05）；重型DAI患者胼胝体压部、丘脑、脑干部位FA值分别低于中型DAI患者（P〈0．05）；DAI患者伤后6个月胼胝体压部、丘脑、脑干部位FA值分别低于该部位人院时FA值（P〈0．05）；DAI患者入院时胼胝体压部、丘脑、脑干部位FA值与伤后6个月GOS呈正相关（P〈0．05）。结论中、重型DAI患者胼胝体压部、丘脑及脑干部位FA值越低，其损伤程度越重，预后越差。DTI可以作为DAI患者判断预后的手段之一。Objective To investigate the application of diffusion tensor imaging （DTI） in evaluating prognosis of patients with moderate and severe diffuse axonal injury （DAI）. Methods A prospective cohort study was made on 35 patients with moderate and severe DAI, who were enrolled from June 2013 to December 2015 as study group. There were 21 males and 14 females, with age of （55.1 ± 11.6） years. The Glasgow coma scale （GCS） was （8.2 ± 2.9） points on admission. Moderate DAI was seen in 20 patients and severe DAI in 15 patients. Other 15 healthy volunteers were selected as control group. Fractional anisotropy （FA） was measured by DTI in three areas of interests as follows： the corpus callosum, thalamus, and brainstem areas. Glasgow outcome scale （GOS） was adopted to assess the prognosis of DAI patients at 6 months after the injury. The FA values of the three areas between study group and control group as well as FA values of patients when they were admined to hospital and 6 months after injury were measured. In this way, the relationship between the FA values of different areas of interests in DAI patients on admission and the prognosis 6 months after injury was analyzed. Results The FA values of the corpus callosum, thalamus and brainstem area in study group were all lower than those in control group （P 〈 O. 05）. Further, FA values of the corpus callosum, thalamus, brainstem area in severe DAI patients were lower than those of moderate DAI patients （ P 〈 0. 05 ）. FA values of the corpus eallosum, thalamus, brain stem areas in DAI patients at 6 months after injury were lower than those of corresponding areas when DAI patients were admitted to hospital （ P 〈 0.05 ）. FA values of the corpus callosum, thalamus and brain stem on admission were significantly positively correlated with GOS at 6 months after injury （ P 〈 0.05 ）. Conclusions Lower FA values of the corpus callosum, thalamus and brainstem area in patients with moderate and severe DAI are associated with more seve

关 键 词：弥漫性轴索损伤 弥散张量成像 预后 

分 类 号：R651.15[医药卫生—外科学]