弥散张量成像技术在保守治疗高血压脑出血患者预后评估中的应用  

Application of diffusion tensor imaging in the prognosis evaluation of patients with hypertensive intracerebral hemorrhage under conservative treatment

作　　者：张晓飞 刘兴宇[1] 崔建忠[1] 田宝刚 王凯杰[1] 洪军[1] 王余[2] 王海波[1] 魏建强[1] 魏玲 ZHANG Xiaofei;LIU Xingyu;CUI Jianzhong;TIAN Baogang;WANG Kaijie;HONG Jun;WANG Yu;WANG Haibo;WEI Jianqiang;WEI Ling(Department of Neurosurgery,Tangshan Gongren Hospital,Tangshan 063000,China)

机构地区：[1]唐山市工人医院神经外科,河北唐山063000 [2]唐山市工人医院核磁共振室,河北唐山063000

出　　处：《实用医学杂志》2019年第15期2465-2468,共4页The Journal of Practical Medicine

基　　金：河北省科技支撑项目(编号:162777156)

摘　　要：目的探讨弥散张量成像技术(DTI)在保守治疗高血压脑出血(HICH)患者预后评估中的应用。方法收集基底节区HICH患者38例,头颅CT示出血体积15~30 mL,所有患者入院48 h内及住院21 d时行DTI检测脑组织患侧及健侧大脑脚、内囊区域各向异性分数(FA)均值并进行皮质脊髓束(CST)分级,所有患者均采取内科保守治疗,根据CST分级,将患者分为内1组(CST 1~2级)和内2组(CST 3级)。应用美国国立卫生研究院卒中量表(NIHSS)于入院及住院21 d时评估患者四肢运动能力,四肢NIHSS量表得分相加的总分为瘫痪分级(PG),分析HICH患者预后的影响因素,探讨DTI在HICH患者预后评估中的应用价值。结果 CST 1~2级患者住院21 d时PG值高于CST 3级患者PG值(t=-2.272,P=0.029)。协方差分析,校正LDL-C、SBP、血肿体积、入院时脑组织患侧FA均值等因素后,CST 1~2级患者住院21 d时PG值仍高于CST 3级患者PG值(F=6.006,P=0.001)。Pearson相关分析,HICH患者入院时脑组织患侧FA均值(r=-0.757,P=0.000)、CST分级(r=0.354,P=0.029)与住院21 d时PG值相关。多元线性回归分析后,校正性别、年龄、血肿体积、收缩压等因素后,HICH患者入院时脑组织患侧FA均值(B=-12.696,SE=2.346,β=-0.473,t=-5.412,P <0.001)与住院21 d时PG值仍相关。结论 HICH患者脑组织患侧FA均值越低,预后越差;CST 3级的HICH患者预后差于CST 1~2级患者,应密切观察。Objective To explore the application of diffusion tensor imaging(DTI)in the prognosis of patients with hypertensive intracerebral hemorrhage(HICH)under conservative treatment. Methods 38 HICH patients with hematoma volume from 15 to 30 mL. All patients were tested by DTI within 48 hours after admission and 21 days after admission. The mean fractional anisotropy(FA)value in brain foot and inner capsule area,as well as the corticospinal tract(CST)integrity grading were obtained. The National Institutes of Health Stroke Scale(NIHSS)was used to assess the patient′s limb mobility within 48 hours after admission and 21 days after admission. The total score of the limbs NIHSS scale was paralysis rating(PG). According to CST grading,patients were divided into two groups:CST 1 ~ 2 grade and CST 3 grade groups. Results The PG value of CST 1 ~ 2 grade group was higher than that of CST 3 grade group(t =-2.272,P = 0.029)at the time hospitalization for 21 days. Using covariance analysis adjusted the following factors:LDL-C,SBP,hematoma volum,and the mean FA values of the damaged brain tissue at the time admitted to hospital,the PG value of CST 1-2 grade group was also higher than that of CST 3 grade group(F = 6.006,P = 0.001). Moreover,Pearson analysis showed that the mean FA values of the damaged brain tissue(r =-0.757,P = 0.000)and CST grading(r = 0.354,P = 0.029)at the time admitted to hospital were correlated with the PG value at the time hospitalization for 21 days in HICH patients. Further,Logistic analysis showed that the mean FA values of the damaged brain tissue at the time admitted to hospital were still associated with the PG value at the time hospitalization for 21 days(B =-12.696,SE= 2.346,β=-0.473,t =-5.412,P < 0.001). Conclusions The lower the mean value of FA in the affected side of brain tissue in HICH patients,the worse the prognosis. The prognosis of HICH patients with CST grade 3 is worse than that of patients with CST grade 1 ~ 2,which should be closely observed.

关 键 词：高血压脑出血 基底节 保守治疗 弥散张量成像技术 预后 

分 类 号：R544.1[医药卫生—心血管疾病] R743.34[医药卫生—内科学] R445.2[医药卫生—临床医学]