特发性正常压力脑积水颅内体积参数与临床症状关系的研究  

Relationships between intracranial compartment volumes and clinical symptoms in patients with idiopathic normal pressure hydrocephalus before and after cerebrospinal fluid shunt surgery

作　　者：何文杰 方旭昊 王小伟 高盼 舒卫权 高幸 郑洁皎 常杰 滑炎卿[1] 毛仁玲 He Wenjie;Fang Xuhao;Wang Xiaowei;Gao Pan;Shu Weiquan;Gao Xing;Zheng Jiejiao;Chang Jie;Hua Yanqing;Mao Renling(Department of Radiology,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China;Department of Medical Imaging,the First Affiliated Hospital of Shenzhen University(the Second People's Hospital of Shenzhen),Shenzhen 518035,China;Department of Neurosurgery,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China;Department of Rehabilitation Medicine,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China;Department of Neurology,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院医学影像科,上海200040 [2]深圳大学第一附属医院(深圳市第二人民医院)医学影像科,深圳518035 [3]复旦大学附属华东医院神经外科,上海200040 [4]复旦大学附属华东医院康复医学科,上海200040 [5]复旦大学附属华东医院神经内科,上海200040

出　　处：《中华老年医学杂志》2020年第1期51-56,共6页Chinese Journal of Geriatrics

基　　金：上海市卫生和计划生育委员会面上项目(201740003);上海市卫生系统重要薄弱学科建设(康复医学)(2015ZB0402);上海市卫生系统重要薄弱学科建设(老年医学)(2015ZB0501)。

摘　　要：目的探讨特发性正常压力脑积水(iNPH)患者术前颅内体积参数与术前临床症状严重程度及术后1年临床症状改善程度的关系。方法收集我院神经外科2016年1月至2017年2月符合国际iNPH指南诊断标准,并行脑脊液分流术的患者21例。所有患者术前行头颅磁共振扫描,并于术前及术后1年门诊复诊采用一致的临床症状指标进行评估,评估内容包括3 m计时起立行走试验(TUG)、简易精神状态量表检查(MMSE)、日本特发性正常压力脑积水分级评分(iNPHGS)与改良Rankin量表(mRS)。测量患者术前头颅影像资料中的脑室体积、脑实质体积、脑室外脑脊液体积、颅内容积,并计算相对脑室体积、脑实质比、脑室外脑脊液比、脑室内外脑脊液比,同时测量所有患者术前的Evans指数。结果iNPH患者术后无论是步态、认知功能还是排尿功能的评分较术前均有所改善(均P<0.05)。患者术前颅内体积参数(相对脑室体积、脑实质比、脑室外脑脊液比、脑室内外脑脊液比)、Evans指数与术前步态、认知功能及排尿功能的严重程度以及术后临床症状改善情况的相关性均无统计学意义(均P>0.05)。在分流术后1年随访点,mRS(17例比4例)、TUG(18例比3例)、MMSE(10例比11例)以及iNPHGS(17例比4例)有改善患者与无改善患者比较颅内体积参数的差异均无统计学意义(均P>0.05)。结论分流手术可以使iNPH患者步态、认知功能及排尿功能障碍等症状得到改善,但iNPH患者术前颅内体积参数(相对脑室体积、脑实质比、脑室外脑脊液比、脑室内外脑脊液比)、Evans指数与术前临床症状严重程度、术后1年症状改善程度无相关性,无法用于预测分流手术是否可以改善特定的临床症状。Objective To investigate the relationships of intracranial compartment volumes with the severity of clinical symptoms before surgery,and the degree of symptom improvement one year after cerebrospinal fluid(CSF)shunt surgery in patients with idiopathic normal pressure hydrocephalus(iNPH).Methods Twenty-one patients meeting the diagnosis criteria of international guidelines of iNPH and undergoing CSF shunt surgery in Department of Neurosurgery in our hospital from 2016 to 2017 were included.All patients underwent brain MRI measurement before surgery,and were evaluated by using 3-meter timed up and go test(TUG),minimum mental state examination(MMSE),idiopathic normal pressure hydrocephalus grading scale(iNPHGS)and modified Rankin scale(mRS)before and one year after CSF shunt procedures.The ventricular volume,brain volume,pericerebral CSF volume,total intracranial volume and Evans'index were measured in the pre-operative imaging of the brain.The following four pre-operative intracranial compartment volumes were calculated:the relative ventricular volume,brain volume ratio,pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume.Results The scores of gait,cognitive function and urinary function were improved after surgery in iNPH patients(all P<0.05).There were no significant difference in the correlation of intracranial compartment volumes(the relative ventricular volume,brain volume ratio,pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans'index with the severity of clinical symptoms including gait,cognitive function and urinary function before surgery,and with the degree of symptom improvement one year after surgery in iNPH patients(all P>0.05).There was no significant difference in intracranial compartment volumes between patients having improvement in mRS,TUG,MMSE and iNPHGS and patients having no improvement one year after surgery in iNPH patients(all P>0.05).Conclusions Patients with iNPH can benefit from CSF shunt surgery an

关 键 词：脑积水 正常压力 脑室 脑脊髓液分流术 

分 类 号：R651[医药卫生—外科学] R742[医药卫生—临床医学]