急进高原人群脑形态学变化的磁共振成像研究  

MRI Investigation of Cerebral Morphological Changes in People Rapidly Entering Plateau

作　　者：张诗雨 冯杰[1] 刘文佳[1] 张维 马林[1] ZHANG Shiyu;FENG Jie;LIU Wenjia;ZHANG Wei;MA Lin(Department of Radiology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心放射诊断科,北京100853 [2]中国科学院高能物理研究所,北京100049

出　　处：《中国医学影像学杂志》2019年第8期574-577,共4页Chinese Journal of Medical Imaging

摘　　要：目的探讨急进高原人群全脑、灰质、白质、脑脊液体积的变化,分析急性高原反应(AMS)的发生机制。资料与方法对47名平原居住的健康青年志愿者(18~40岁)在平原及到达高原的(8±2)h内,进行2次三维快速扰向梯度回波扫描,完成路易斯湖急性高原反应评分(LLS)问卷。依据LLS分值,将受试者分为AMS组(LLS≥3)与无AMS组(LLS<3)。测量全脑、灰质、白质、脑脊液的体积,比较各成分脑体积在平原及高原的差异,并比较其改变比例在两组间的差异。分析LLS与各成分脑体积改变的相关性。结果47名受试者急进高原后全脑与灰质体积分别为(1562.90±138.83)ml、(718.39±46.50)ml,较平原的(1555.48±139.87)ml和(703.05±48.88)ml显著增加(P均<0.001);白质与脑脊液体积分别为(536.69±61.51)ml、(540.60±60.15)ml,较平原的(310.93±45.27)ml和(314.61±46.99)ml显著减小(P均<0.05)。AMS组灰质体积改变比例绝对值大于无AMS组(P=0.012),LLS与灰质体积改变呈显著正相关(r=0.469,P=0.001)。结论急性暴露于高原低压缺氧环境短时间内会导致全脑与灰质体积增加,而白质与脑脊液体积减小,且灰质体积增加可能参与AMS的发生机制。Purpose To investigate the changes of whole brain,gray matter,white matter and cerebrospinal fluid volume in people rapidly entering plateau,and to analyze the mechanism of acute mountain sickness (AMS).Materials and Methods Forty-seven healthy young volunteers (18-40 years old) living in the plain were scanned twice by 3D-FSPGR within (8±2) h in plain and after arrival at plateau, and the lake Louise acute mountain sickness score (LLS) questionnaire was completed.According to LLS,the subjects were divided into AMS group (LLS≥3) and non-AMS group (LLS<3).The volumes of whole brain,gray matter,white matter and cerebrospinal fluid were measured,the differences of brain volume of each component in plain and plateau were compared,and the differences of change proportion were compared between the two groups.The correlation between LLS and the changes to brain volume was analyzed.Results In 47 people rapidly entering plateau,the volume of whole brain and gray matter [(1562.90±138.83) ml and (718.39±46.50) ml] increased significantly (all P<0.001) compared with that in plain [(1555.48±139.87) ml and (703.05±48.88) ml],and the volume of white matter and cerebrospinal fluid [(310.93±45.27) ml and (314.61±46.99) ml] decreased significantly (all P<0.05) compared with that in plain [(536.69±61.51) ml and (540.60±60.15) ml].The absolute value of volume change ratio of gray matter in AMS group was higher than that in non-AMS group (P=0.012).LLS was positively correlated with the volume change of gray matter (r=0.469,P=0.001).Conclusion Acute exposure to plateau with hypobaric hypoxic environment in a short period of time may result in the increase in the volume of whole brain and gray matter,but decrease in the volume of white matter and cerebrospinal fluid,and the increased gray matter volume may be involved in the pathogenesis of AMS.

关 键 词：高原病 急性病 磁共振成像 高海拔 脑 白质 灰质 

分 类 号：R445.2[医药卫生—影像医学与核医学]