DTI及DTT技术在小量高血压性基底节区出血运动功能预后评估中的应用  

Application of DTI and DTT in evaluation of motor function in patients with mild hypertensive basal ganglia hemorrhage

作　　者：肖国辉 李经纶 曹付强 扶宇 王本瀚 XIAO Guo-hui;LI Jing-lun;CAO Fu-qiang;FU Yu;WANG Ben-han(Xinxiang Medical University,Xinxiang 453003,China;Department of Neurosurgery,The 988th Hospital of The Joint Logistics Support Force,PLA,450007 Zhengzhou,China)

机构地区：[1]新乡医学院,河南新乡453003 [2]解放军联勤保障部队第988医院神经外科,郑州450007

出　　处：《中国临床神经外科杂志》2021年第8期593-596,621,共5页Chinese Journal of Clinical Neurosurgery

基　　金：中国人民解放军联勤保障部队面上项目(CJN16J004)。

摘　　要：目的探讨磁共振弥散张量成像技术(DTI)及其重建技术(DTT)在小量(血肿量<30 ml)高血压性基底节区出血(HB⁃GH)病人运动功能预后评估中的价值。方法2018年5月至2020年5月前瞻性收集小量HBGH共18例(观察组),发病3 d行DTI和DTT检查,另选取10例健康人DTI数据为对照,选取相对剩余皮质脊髓束(CST)条目数、相对各项异性分数(rFA)、CST分级三个评估参数。发病3个月采用Fugl-Meyer运功功能量表(FMA)评分评估HBGH病人运动功能预后,FMA评分≥96分为预后良好,<96分为预后不良。结果发病3个月,预后良好6例,预后不良12例。与对照组相比,观察组相对剩余CST条数和rFA明显降低(P<0.05),CST分级显著增高(P<0.05)。与预后不良组相比,预后良好组相对剩余CST条数和rFA明显增高(P<0.05),CST分级显著降低(P<0.05)。发病3个月FMA评分与相对剩余CST条目数(r=0.809)、rFA(r=0.784)呈明显正相关(P<0.05),与CST分级(r=-0.785)呈明显负相关(P<0.05)。ROC曲线分析显示,相对剩余CST条目数≤77.000预测预后不良的曲线下面积(AUC)为0.882(P<0.05),敏感度为83.3%,特异度为91.7%;rFA≤0.630预测预后不良的AUC为0.840(P<0.05),敏感度为83.3%,特异度为0.833;CST分级≥1.500预测预后不良的AUC为0.799(P<0.05),敏感度为66.7%,特异度为91.7%;3个参数联合预测的AUC为0.917(P<0.05),敏感度为84.0%,特异度为92.1%。结论小量HBGH急性期DTI和DTT检查参数相对剩余CST条目数、rFA、CST分级可以预测病人运动功能预后。Objective To explore the clinical value of diffusion tensor imaging(DTI)and diffusion tensor tractography(DTT)in the evaluation of motor function in the patients with mild(<30 ml)hypertensive basal ganglia hemorrhage(HBGH).Methods DTI and DTT were performed on the 18 patients(observation group)with mild HBGH who were prospectively recruited from May 2018 to May 2020 within 3 days after the onset.In addition,the DTI data obtained from 10 healthy people were served as control.The parameters of DTI and DTT included the number of remaining corticospinal tract(CST),relative fractional anisotropy(rFA),and CST grade.The Fugl Meyer function scale(FMA)score was used to evaluate the prognosis of the HBGH patient's motor function 3 months after the onset,with a good prognosis of FMA score≥96 points,and a poor prognosis of FMA score<96 ponits.Results A good prognosis was achieved in 6 patients with HBGH,and poor in 12.Compared with the control group,the number of remaining CST and rFA were significantly reduced and the CST grade was significantly increased in the observation group(P<0.05).Compared with the poor prognosis group,the number of remaining CST and rFA were significantly increased and the CST grade was significantly reduced in the good prognosis group(P<0.05).The FMA score at 3 months after the onset was significantly positively correlated with the number of remaining CST(r=0.809,P<0.05)and rFA(r=0.784,P<0.05),and significantly negatively correlated with the CST grade(r=-0.785,P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the number of remaining CST≤77.000 to predict the poor prognosis was 0.882(P<0.05),with a sensitivity of 83.3%and a specificity of 91.7%;the AUC of rFA≤0.630 was 0.840(P<0.05),with a sensitivity of 83.3%and a specificity of 0.833;the AUC of CST grade≥1.500 was 0.799(P<0.05),with a sensitivity of 66.7%and a specificity od 91.7%;the AUC of the combination of these three parameters was 0.917(P<0.05),with a sensitivity of 84.0%and a specificity of 92.1%.Conclusions DTI

关 键 词：高血压性脑出血 基底节区 小量脑出血 磁共振弥散张量成像 皮质脊髓束 运动功能预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]