表观弥散系数联合振幅整合脑电图技术预测重型颅脑损伤昏迷患者的预后研究  

Combination of apparent diffusion coefficient and amplitude-integrated electroencephalogram to predict the outcome of comatose patients with severe traumatic brain injury

作　　者：宋春杰 李俊 徐海清[2] 徐峰 仲银节 Song Chunjie;Li Jun;Xu Haiqing;Xu Feng;Zhong Yinjie(Department of Neurology,Suqian First Hospital,Suqian 223899,Jiangsu,China;Department of Neurology,Xuzhou Central Hospital,Xuzhou 221009,Jiangsu,China)

机构地区：[1]宿迁市第一人民医院神经内科,江苏宿迁223899 [2]徐州市中心医院神经内科,江苏徐州221009 [3]宿迁市第一人民医院影像中心,江苏宿迁223899

出　　处：《中华危重病急救医学》2021年第5期609-612,共4页Chinese Critical Care Medicine

基　　金：江苏省宿迁市产业发展引导资金项目(S201905)。

摘　　要：目的探讨表观弥散系数(ADC)联合振幅整合脑电图(aEEG)检查预测重型颅脑损伤(sTBI)昏迷患者的预后。方法采用前瞻性研究方法,纳入2016年1月至2019年6月在宿迁市第一人民医院因sTBI导致昏迷〔格拉斯哥昏迷评分(GCS)<8分〕的住院患者。所有患者于急救治疗1周内进行aEEG检查和头颅磁共振成像(MRI)扫描。其中头颅MRI测量9个感兴趣区(额叶灰质和白质、顶叶灰质和白质、颞叶灰质和白质、基底节区尾状核、豆状核、丘脑)的ADC值,并分别计算出额叶、顶叶、颞叶和基底节区的ADC均值。根据12个月后的随访结果,比较预后不良〔格拉斯哥预后评分(GOS)1~2级〕与预后良好(GOS 3~5级)患者各指标的差异;绘制受试者工作特征曲线(ROC曲线),评价aEEG和ADC对sTBI患者预后良好的预测能力,以及aEEG与ADC联合的预测价值。结果共入组52例sTBI患者,平均年龄(36.7±13.9)岁,其中男性35例;随访12个月后,有29例患者预后良好,23例预后不良。aEEGⅠ、Ⅱ、Ⅲ级患者分别为21、17、14例,相应有19、10、0例患者预后良好。预后良好组患者的9个感兴趣区ADC值均显著高于预后不良组(×10^(-6)mm^(2)/s:额叶灰质为924±107比531±87,额叶白质为804±95比481±74,颞叶灰质为831±93比683±72,颞叶白质为726±87比654±63,顶叶灰质为767±79比690±75,顶叶白质为716±84比642±62,尾状核为689±70比465±68,豆状核为723±84比587±71,丘脑为807±79比497±67,均P<0.01)。ROC曲线分析显示,aEEG预测sTBI患者预后良好的ROC曲线下面积(AUC)为0.826,最佳截断值为<1.5级时,敏感度和特异度分别为94.7%、72.8%;在各感兴趣区ADC值预测能力中,以额叶和基底节区ADC值预测sTBI患者预后良好的特异度较高,AUC分别为0.817、0.903,最佳截断值分别为>726×10^(-6)mm^(2)/s、>624×10^(-6)mm^(2)/s时,预测预后良好的敏感度均为100%,特异度分别为63.4%、61.8%。多模态评估显示,额叶ADC、基底节区ADC与aObjective To examine whether the combination of quantitative regional apparent diffusion coefficient(ADC)and amplitude-integrated electroencephalogram(aEEG)can predict the outcome of comatose patients with severe traumatic brain injury(sTBI).Methods A prospective study was conducted.The patients with coma caused by sTBI[Glasgow coma scale(GCS)<8]admitted to Suqian First Hospital from January 2016 to June 2019 were enrolled.All patients underwent aEEG examination and magnetic resonance imaging(MRI)scan within 1 week after emergency treatment.The ADC values of 9 regions of interest(frontal gray matter and white matter,parietal gray matter and white matter,temporal gray matter and white matter,caudate nucleus of basal ganglia,lenticular nucleus and thalamus)were measured by head MRI,and the mean ADC values of frontal lobe,parietal lobe,temporal lobe and basal ganglia were calculated respectively.According to the follow-up results after 12 months,the differences of each index between patients with poor prognosis[Glasgow outcome score(GOS)1-2]and patients with good prognosis(GOS 3-5)were compared;the receiver operating characteristic curve(ROC curve)was drawn to evaluate the predictive ability of aEEG and ADC for the good prognosis of patients with sTBI,and the predictive value of the combination of aEEG and ADC.Results A total of 52 patients with sTBI were enrolled,with mean age of(36.7±13.9)years old,35 of whom were male.Within 12 months follow-up,29 patients had achieved favorable outcomes and 23 patients had unfavorable outcome.There were 21,17 and 14 patients with aEEG,and grade,respectively,and 19,10 and 0 patients had good prognosis respectively.ADC values of 9 regions of interest in patients with good prognosis were significantly higher than those in patients with poor prognosis(×10^(-6)mm^(2)/s:924±107 vs.531±87 in frontal gray matter,804±95 vs.481±74 in frontal white matter,831±93 vs.683±72 in temporal gray matter,726±87 vs.654±63 in temporal white matter,767±79 vs.690±75 in parietal gray matter,

关 键 词：重型颅脑损伤 振幅整合脑电图 表观弥散系数 预后 

分 类 号：R651.15[医药卫生—外科学]