磁共振波谱成像联合弥散加权成像对自发性脑出血后二次脑损伤的预测价值  

Predictive value of magnetic resonance spectroscopy combined with diffusion weighted imaging in patients with secondary brain insult after spontaneous intra-cerebral hemorrhage

作　　者：蔡勇[1] 钟兴明[1] 汪一棋[1] 阳建国[1] 赵朝辉[1] 费振海 张磊[1] 顾华[1] 杨涛[1] Cai Yong;Zhong Xingming;Wang Yiqi;Yang Jianguo;Zhao Zhaohui;Fei Zhenhai;Zhang Lei;Gu Hua;Yang Tao(Department of Neurosurgery,the First People's Hospital of Huzhou(the First Affiliated Hospital of Huzhou University),Huzhou 313000,Zhejiang,China)

机构地区：[1]湖州市第一人民医院(湖州师范学院附属第一医院)神经外科,浙江湖州313000

出　　处：《中华危重病急救医学》2020年第11期1336-1339,共4页Chinese Critical Care Medicine

基　　金：浙江省湖州市科技计划项目(2015GYB02)。

摘　　要：目的探讨磁共振波谱成像(MRS)检测的N-乙酰天冬氨酸/肌酸(NAA/Cr)和弥散加权成像(DWI)测定的相对表观扩散系数(rADC)变化与自发性脑出血(SICH)患者二次脑损伤(SBI)发生和预后的关系。方法选择湖州市第一人民医院2014年1月至2019年12月收治的108例头颅CT提示为SICH患者作为研究对象。于入院后第2天常规行MRS及DWI检查,连续监测患者体温、血压、血糖、血钠、动脉血氧分压(PaO2)等指标,根据是否存在二次脑损伤因素(SBIF)将患者分为SBI组(46例)和对照组(62例)。比较两组患者脑水肿区域NAA/Cr和rADC以及6个月后格拉斯哥预后评分(GOS)的差异;采用多因素Logistic回归分析影响SBI发生的危险因素。结果SBI组脑血肿周围水肿区域NAA/Cr、rADC和6个月后GOS均明显低于对照组〔NAA/Cr:1.64±0.35比1.87±0.41,rADC:2.57±0.39比2.75±0.45,6个月后GOS(分):3.47±0.59比3.76±0.65〕,差异均有统计学意义(均P<0.05)。Logistic回归分析显示,NAA/Cr、rADC是SBI发生的危险因素〔优势比(OR)值分别为0.172、0.343,95%可信区间(95%CI)分别为0.048~0.609、0.118~0.996,均P<0.05〕。结论MRS联合DWI对预测SICH后SBI有一定价值,SBI可加重脑损伤,影响患者的预后,应积极预防SBI并进行干预治疗。Objective To investigate the correlations between the changes of N-acetylaspartate/creatine(NAA/Cr)detected by magnetic resonance spectroscopy(MRS),and of the relative apparent diffusion coefficient(rADC)detected by diffusion weighted imaging(DWI)and the occurrence and outcome of secondary brain injury(SBI)in patients with spontaneous intra-cerebral hemorrhage(SICH).Methods One hundred and eight SICH patients diagnosed by CT from January 2014 to December 2019 in the First People's Hospital of Huzhou were selected as the research objects.MRS and DWI examinations were performed on day 2 after admission.The body temperature,blood pressure,blood glucose,blood sodium,arterial oxygen partial pressure(PaO2)and other indexes were continuously monitored.The patients were divided into two groups:SBI group(46 cases)and control group(62 cases)according to whether there were secondary brain injury factors(SBIF).The differences in NAA/Cr and rADC of the edema area and Glasgow outcome score(GOS)after 6 months were compared between the two groups;multivariate Logistic regression analysis was used to analyze the risk factors of SBI.Results The NAA/Cr and rADC of perihematoma edema area and GOS after 6 months in SBI group were significantly lower than those in control group[NAA/Cr:1.64±0.35 vs.1.87±0.41,rADC:2.57±0.39 vs.2.75±0.45,GOS after 6 months(points):3.47±0.59 vs.3.76±0.65],with significant differences(all P<0.05).Logistic regression analysis showed that NAA/Cr and rADC were the risk factors for the occurrence of SBI[odds ratio(OR)values were 0.172,0.343,95%confidence intervals(95%CI)were 0.048-0.609 and 0.118-0.996,respectively,both P<0.05].Conclusions MRS combined with DWI has a certain value in predicting SBI after SICH.SBI can aggravate brain injury and affect the prognosis of patients.SBI should be actively prevented and intervention,carried out.

关 键 词：自发性脑出血 磁共振波谱成像 弥散加权成像 二次脑损伤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.34[医药卫生—诊断学]