^(1)H-MRS对一氧化碳中毒迟发性脑病的预测  

Prediction of delayed encephalopathy after carbon monoxide poisoning by ^(1)H-MRS and analysis of its risk factors

作　　者：王思琪 赵年[2] WANG Siqi;ZHAO Nian(不详;Department of Medical Imaging,Sinopharm Dongfeng General Hospital of Jinzhou Medical University,Shiyan 442000,China)

机构地区：[1]锦州医科大学,辽宁锦州121000 [2]湖北医药学院附属国药东风总医院医学影像科,湖北十堰442000

出　　处：《中国中西医结合影像学杂志》2021年第4期330-334,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的:探讨^(1)H-MRS测量胆碱(Cho)/肌酸(Cr)、Cho/N-乙酰天门冬氨酸(NAA)值对一氧化碳中毒迟发性脑病(DEACMP)的预测,并分析发病因素。方法:选择100例急性一氧化碳中毒患者,随访3个月,根据DEACMP诊断标准,分成DEACMP组51例和非DEACMP组49例;同时选择健康志愿者60例作为对照组。比较3组的Cho/Cr和Cho/NAA值,绘制ROC曲线预测DEACMP的发生;单因素分析DEACMP组的基线资料;Logistic回归分析确定DEACMP发生的独立影响因素。结果:3组受试者的Cho/Cr和Cho/NAA水平差异均有统计学意义(均P<0.05);DEACMP组Cho/Cr和Cho/NAA水平明显高于非DEACMP组和对照组(均P<0.05),非DEACMP组Cho/Cr和Cho/NAA水平明显高于对照组(均P<0.05)。ROC曲线表明,Cho/NAA诊断DEACMP的临界值为1.92,其对应的敏感度为80.39%,特异度为79.82%,AUC为0.826,95%置信区间(95%CI)(0.774,0.877);Cho/Cr诊断的临界值为1.98,其对应的敏感度为78.43%,特异度为77.98%,AUC为0.784,95%CI(0.758,0.810);平行联合诊断的敏感度为90.20%,特异度为73.39%,AUC为0.903,95%CI(0.804,0.899)。Logistic回归分析表明,昏迷时间(>24 h)[OR=2.401,95%CI(1.585,3.638)]、Glasgow评分(0~5分)[OR=2.018,95%CI(1.071,3.800)]、高压氧治疗次数(≤10次)[OR=2.770,95%CI(2.238,3.430)]、Cho/NAA(>1.92)[OR=2.482,95%CI(1.373,4.486)]和Cho/Cr(>1.98)[OR=2.234,95%CI(1.301,3.838)]是DEACMP发生的独立危险因素(均P<0.05)。结论:1H-MRS测量Cho/Cr和Cho/NAA单独和联合诊断可预测DEACMP发生,且昏迷时间(>24 h)、Glasgow评分(0~5分)、高压氧治疗次数(≤10次)、Cho/NAA(>1.92)、Cho/Cr(>1.98)是其发生的独立危险因素;临床宜根据上述因素采取相应措施以降低DEACMP的发生率,提高患者生活质量。Objective:To predict delayed encephalopathy after carbon monoxide poisoning(DEACMP)with Cho/Cr and Cho/NAA ratio measured by ^(1)H-MRS and analyze its risk factors.Methods:A total of 100 patients with acute carbon monoxide poisoning were followed up for 3 months.According to the diagnostic criteria for DEACMP,the patients were divided into DEACMP group(51 cases)and non-DEACMP group(49 cases).Sixty healthy volunteers were served as control group(60 cases).The Cho/Cr and Cho/NAA ratios in the three groups were compared,and the ROC curve was drawn to predict the occurrence of DEACMP.The baseline data of DEACMP group were analyzed by univariate analysis,and the independent influencing factors of DEACMP were determined by Logistic regression analysis.Results:There were significant differences in the ratios of Cho/Cr and Cho/NAA among the three groups(P<0.05).The ratios of Cho/Cr and Cho/NAA in the DEACMP group were significantly higher than those in the non-DEACMP group and the control group,and the ratios of Cho/Cr and Cho/NAA in the non-DEACMP group were significantly higher than those in the control group(all P<0.05).ROC curve results showed the cut-off value of Cho/NAA for the diagnosis of DEACMP was 1.92,with the corresponding sensitivity of 80.39%,the specificity of 79.82%,and the AUC of 0.826[95%CI(0.774,0.877)].The cut-off value of Cho/Cr was 1.98,with the corresponding sensitivity of 78.43%,the specificity of 77.98%,and the AUC of 0.784[95%CI(0.758,0.810)].The sensitivity of parallel combined detection was 90.20%,the specificity was 73.39%,and the AUC was 0.903[95%CI(0.804,0.899)].The Logistic regression analysis showed that coma time(>24 h)[OR=2.401,95%CI(1.585,3.638)],Glasgow score(0~5)[OR=2.018,95%CI(1.071,3.800)],times of hyperbaric oxygen treatment(≤10 times)[OR=2.770,95%CI(2.238,3.430)],Cho/NAA(>1.92)[OR=2.482,95%CI(1.373,4.486)]and Cho/Cr(>1.98)[OR=2.234,95%CI(1.301,3.838)]were independent risk factors for DEACMP(P<0.05).Conclusions:Cho/Cr plus Cho/NAA measured by 1H-MRS,used alone or in combination

关 键 词：磁共振波谱 胆碱 肌酸 N-乙酰天门冬氨酸 一氧化碳中毒 迟发性脑病 

分 类 号：R595.1[医药卫生—内科学] R747.9[医药卫生—临床医学]