颈髓损伤后骶髓DTI影像学变化与膀胱收缩指数的关系  

Relationship between sacral changes characterized by diffusion tensor imaging and bladder contractility in cervical SCI persons

作　　者：朱红军[1] 戴慧[2] 张大伟[1] 刘传道[1] 昝云强[1] 蔡萍[1] 杨卫新[1] ZHU Hongjun;DAI Hui;ZHANG Dawei(Department of Rehabilitation Medicine,The First Affiliated Hospital of Soochow University,Suzhou,215000)

机构地区：[1]苏州大学附属第一医院康复医学科,苏州215000 [2]苏州大学附属第一医院影像医学科

出　　处：《中国康复医学杂志》2020年第12期1455-1459,共5页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:研究颈髓损伤患者骶髓神经继发性改变,探讨它与膀胱收缩功能的关系。方法:选取20例颈髓损伤后神经源性膀胱患者作为试验对象,另选取15例正常成年人作为对照组。试验组进行尿动力检查评估膀胱收缩功能,所有对象进行骶髓弥散张量成像(diffusion tensor imaging,DTI)检查,分析S2—S4侧角和前角的DTI指标弥散各向异性(fractional anisotropy,FA)和表观弥散系数(apparent diffusion coefficient,ADC)。结果:试验组骶髓侧角和前角的FA值分别为(0.21±0.03)和(0.22±0.03),分别较对照组显著降低(P<0.05);试验组骶髓侧角和前角的ADC值分别为(2.44±0.53)×10^-9 mm^2/s和(2.29±0.31)×10^-9 mm^2/s,分别较对照组显著增加(P<0.05)。试验组骶髓侧角的FA值与膀胱收缩指数(bladder contractility index,BCI)呈正相关(r=0.758,P<0.01),骶髓侧角的ADC值与BCI呈负相关(r=-0.523,P<0.05)。试验组骶髓前角的FA值及ADC值与最大尿道压无明显相关性(P>0.05)。结论:颈髓损伤后骶髓神经发生继发性改变,这些变化可能影响到膀胱收缩功能。Objective:To investigate changes of sacral cord in cervical SCI persons using diffusion tensor imaging(DTI)and determine the relationship between sacral cord changes and bladder contractility.Method:Twenty patients with complete cervical SCI and 15 control subjects,were included in the present study.Fractional anisotropy(FA)and apparent diffusion coefficient(ADC)values of ventral horn and intermediate column at S2-S4 level were calculated by DTI for all subjects and participants with SCI received urodynamic examination.Result:The FA values of sacral dorsal horn and anterior horn in the experimental group were(0.21±0.03)and(0.22±0.03)and the ADC values were(2.44±0.53)×10^-9 mm^2/s and(2.29±0.31)×10^-9 mm^2/s.Compared with the control group,the FA values in the experimental group significantly decreased while the ADC values dramatically increased(P<0.05).The FA value of sacral dorsal horn in the experimental group was positively correlated with bladder contractility index(BCI)(r=0.758,P<0.01)and the ADC value was negatively correlated with BCI(r=-0.523,P<0.05).The values of FA and ADC of sacral anterior horn had no significant correlations with maximal urethral pressure in experimental group.Conclusion:The complete cervical SCI participants showed DTI changes in sacral cord and these changes might affect bladder contraction.

关 键 词：颈髓损伤 弥散张量成像 膀胱收缩指数 神经源性膀胱 

分 类 号：R651.2[医药卫生—外科学] R49[医药卫生—临床医学]