基于结构磁共振探讨创伤性脑损伤后内嗅皮层改变与认知功能的关系  

Association between the entorhinal cortex and cognitive function in traumatic brain injury based on structural magnetic resonance imaging

作　　者：卞益同 陈苗苗 李华[2] 李贤军[1] 葛瑶[1] 商苏杭 杨健 BIAN Yitong;CHEN Miaomiao;LI Hua;LI Xianjun;GE Yao;SHANG Suhang;YANG Jian(Department of Radiology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Department of Radiology,Yulin Second Hospital,Yulin 719000;Department of Neurology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院医学影像科,陕西西安710061 [2]榆林市第二医院影像科,陕西榆林719000 [3]西安交通大学第一附属医院神经内科,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2021年第6期875-879,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：西安交通大学第一附属医院院基金项目(No.2020ZYTS-19)。

摘　　要：目的利用结构磁共振(sMRI)探讨创伤性脑损伤(TBI)后内嗅皮层(EC)变化与后期认知功能的关系。方法对26例临床确诊的TBI患者入院后行磁共振成像(MRI)检查,并于6个月后随访简易智力状态检查量表(MMSE)。根据患者外伤后格拉斯昏迷评分量表(GCS)评分将TBI受试者分为轻度脑外伤组(GCS:13~15分)和中重度脑外伤组(GCS<13分),比较两组间年龄、性别、受教育程度、高血压、糖尿病、TBI手术史及随访MMSE差异,再分别利用视觉评分及Freesurfer软件评估受试者EC形态、表面积、体积及厚度差异,最后利用相关分析法分析EC参数与MMSE的关系。结果本研究纳入轻度脑外伤组12例,中重度脑外伤组14例,两组间年龄、性别、受教育年限、高血压、糖尿病及TBI手术史无统计学差异;两组间随访MMSE有统计学差异(P<0.05)。视觉评估显示,左侧EC评分在两组间有统计学差异(P<0.05),sMRI发现左侧EC体积、厚度在两组间有统计学差异(P<0.05);相关分析显示,左侧EC厚度与MMSE呈正相关(r=0.430,P<0.05)。结论 TBI后EC萎缩程度与外伤严重程度相关,且能够反映远期患者的认知水平,EC可作为评价TBI后认知障碍的无创、可靠的影像学标志物。Objective To explore the relationship between changes in the entorhinal cortex(EC)of traumatic brain injury(TBI)and cognitive function based on structural magnetic resonance imaging. Methods MRI was performed in 26 patients with clinically confirmed TBI after admission,and the Mini-mental State Examination(MMSE)was followed up 6 months later. The TBI patients were classified as mild TBI and moderate to severe TBI according to the post-traumatic Glasgow coma scale(GCS). We compared the differences in age, gender, education level, hypertension, diabetes, TBI operation history, and follow-up MMSE between the two groups. Then the morphology, surface area, volume and thickness of the patient’s EC were evaluated using the visual score and Freesurfer software, and finally the correlation between EC parameters and MMSE was analyzed. Results The study included 12 cases of mild TBI and 14 cases of moderate to severe TBI. There were no statistical differences in age,gender,years of education,hypertension,diabetes or TBI operation history. However, the two groups differed significantly in follow-up MMSE. Visual evaluation showed statistical difference in the left EC scores. Structural MRI showed that the volume and thickness of left EC were statistically different between the two groups. The correlation analysis showed that there was a positive correlation between the thickness of left EC and MMSE(r=0. 430, P<0. 05). Conclusion Entorhinal cortex atrophy after TBI is related to the severity of trauma, and it can reflect the long-term cognitive level of patients, which can be used as a noninvasive and reliable imaging marker for evaluating cognitive impairment after TBI.

关 键 词：创伤性脑外伤 内嗅皮层 认知功能 结构磁共振成像 

分 类 号：R651.15[医药卫生—外科学]