外伤性中脑损伤早期质子磁共振波谱分析

目的：通过质子磁共振波谱(^1H MRS)研究外伤性中脑损伤早期异部异常代谢状态及其与预后的关系。方法：在伤后早期，应用^1H MRS技术分别对19例中脑损伤及10例正常对照中脑腹侧区域的代谢变化进行研究，测定胆碱（Cho)、总肌酸（Cr)、N－乙酰天冬氨酸（NAA）、Cho/Cr,Cr/NAA,Cho/NAA等指标，分别分析中脑损伤时谱变化及与Glassgow预后评分（GOS）间的相关关系，同时研究持续昏迷时间不同患间波谱变化的不同。结果：中脑损伤组Cho,Cr,Cho.Cr及Cho/NAA明显下降；NAA，Cr/NAA及Cho/NAA与GOS间存在直线相关关系；昏迷长于30d患局部Cho,Cho/Cr,Cho/NAA值明显低于昏迷短于30d患。结论：损伤局部与Cho,Cr能反映中脑损伤的情况；NAA有助于判断患预后；中脑Cho,Cho/Cr,Cho/NAA下降程度与昏迷时间长短一致。

Proton magnetic resonance spectroscopy (1H MRS) of traumatic midbrain injury at early stage

Objective: : To study the changes of proton magnetic reson a nce spectroscopy (~1H MRS) in cerebral metabolites after traumatic midbrain in jury and to determine whether the changes can predict the outcome of these patie nts. Methods: Nineteen patients with traumatic midbrain injury w ere examined with quantitative ~1H MRS soon after injury (<20 d post injury ), and 10 volunteers were also examined. The Cho, Cr, NAA, Cho/Cr, Cr/NAA, Cho/N AA were all determined, and the relationship between outcome (Glassgow Outcome Scale ) and coma stage were analyzed. Quantitative neurochemical finding s were also analyzed. Results: Patients with brain injury showe d diminished choline(Cho),creatine(Cr),Cho/Cr and Cho/ NAA levels compared with normal control volunteers. N-acetyl aspartate (NAA),Cr/NAA and Cho/NAA le vel correlated with GOS ( P <0.05). Patients in coma over 30 d displayed low ered Cho,Cho/Cr and Cho/NAA compared with other patients. Conclusion: The changes of ~1H MRS in midbrain can reflect local tissue injury after head trauma. There is a strong correlation between NAA and outcome, reducing extent of Cho,C ho/Cr and Cho/NAA level accords with coma stage.