合并阵发性交感神经过度兴奋综合征的意识障碍患者脑部结构特征的研究

目的研究阵发性交感神经过度兴奋综合征(paroxysmal sympathetic hyperactivity,PSH)患者在颅脑结构方面的特征性表现,描画PSH症状患者的特殊脑部结构变化;从而探索性阐述PSH发生的可能区域及机制。方法选择解放军总医院第七医学中心神经外科2018年1月—2018年12月收治的意识障碍(disorders of consciousness,DOC)患者共51例,经过筛选,入组患者34例。其中合并PSH及无合并PSH的患者各17例,分为两组。选用在容积分析菜单普通模式下的多模式节段分割命令,完成初期图像分割,采用手工分割方法在所有能够显示丘脑及脑干的MRI层面上描绘出核团轮廓线,测量比较两组脑干和丘脑体积。结果PSH组患者的脑干体积略大,两组患者的脑干体积差异有统计学意义(P=0.034)。PSH组与无PSH组相比右侧丘脑体积偏小,为(6082.1±1034.1)mm 3,两组差异有统计学意义(P=0.019)。而左侧丘脑体积,PSH组偏大,为(7972.7±2063.9)mm 3,两组的差异有统计学意义(P=0.025)。两组不同患者的PSH联合评分与6个月后昏迷恢复量表修订版(coma recovery scale-revised,CSR-R)评分呈正相关。结论右侧丘脑损伤的DOC患者更容易发生PSH,长期的PSH发作可能会对脑干及丘脑结构有一定的影响。慢性DOC患者的PSH症状出现可能提示更好的预后,在合理控制PSH发作的情况下,其意识水平恢复可能具有更好的潜力。

Study on structural characteristics of brain in patients with consciousness disorder of paroxysmal sympathetic hyperexcitation syndrome

Objective To observe the characteristic features of brain structure of patients with paroxysmal sympathetic hyperactivity(PSH)symptoms and to describe the special brain structure changes of patients with PSH symptoms,so as to explore the possible regions and mechanisms of PSH occurrence.Methods A total of 51 disorders of consciousness(DOC)patients were selected from January 2018 to June 2018 in the Department of Neurosurgery,the 7th Medical Center of PLA General Hospital.After screening,34 patients were enrolled,and 17 patients with and without PSH were divided into two groups.The multi-mode segment segmentation command under the normal mode of the volume analysis menu was selected to complete the initial image segmentation.The manual segmentation method was used to draw the contour lines of the nucleus on all MRI planes capable of displaying thalamus and brainstem.The volume of brainstem and thalamus of the two groups were compared with the image information of corresponding axial scanning for the part that was difficult to identify.Results The brainstem volume of patients in PSH group was slightly larger than that of patients in PSH group.The difference in brainstem volume between the two groups was statistically significant(P=0.034).The volume of right thalamus in PSH group was(6082.1±1034.1)mm 3 smaller than(6206.6±2137.3)mm 3 in group without PSH.The difference between the two groups was statistically significant(P=0.019).The left thalamus volume was(7972.7±2063.9)mm 3 in PSH group and(6538.5±1420.4)mm 3 in non-PSH group.The difference between the two groups was statistically significant(P=0.025).Conclusions The unconnected theory is verified,suggesting that the proposed brain stem and thalamus injury will cause PSH attack.Similarly,the excitation-inhibition rate model theory can explain that long-term PSH attack may have certain influence on the brain stem and thalamus injury structure.