背景轻度创伤性脑损伤（mTBI）较常见且其引发的脑震荡后综合征严重困扰着患者的生活，由于其临床表现相对主观，相关辅助检查阳性率不高，临床诊断尚存争议，因此探寻早期诊断、评估预后的有效检测手段尤为重要。目的探讨磁共振波谱成像（MRS）、事件相关电位（P300）及脑震荡后综合征问卷（RPQ）评分在 mTBI 中的应用价值。方法2012年5月—2015年6月选取东莞东华医院符合纳入标准的 mTBI 患者30例为病例组，同期选取于本院体检健康的志愿者30例为对照组。两组分别进行 MRI 检查、P300检测和 RPQ 评分，分别测量其大脑的基底核、额叶白质、半卵圆中心、胼胝体膝部、胼胝体压部左侧及其右侧的代谢物〔 N -乙酰天冬氨酸（ NAA）、肌酸（Cr）、胆碱（Cho）〕水平，并记录病例组患侧、健侧 NAA/ Cr、Cho/ Cr，对照组左侧、右侧 NAA/ Cr、Cho/ Cr，记录两组 P300波幅、P300潜伏期、RPQ 评分。结果两组常规 MRI 检查均未见异常，病例组额叶白质、半卵圆中心患侧NAA 峰较其健侧下降、Cho 峰较其健侧升高。对照组基底核、额叶白质、半卵圆中心、胼胝体膝部、胼胝体压部左侧NAA/ Cr、Cho/ Cr 与右侧比较，差异无统计学意义（ P ﹥0.05）；病例组基底核、胼胝体膝部、胼胝体压部患侧 NAA/ Cr、Cho/ Cr 与健侧比较，差异无统计学意义（ P ﹥0.05）；病例组额叶白质、半卵圆中心患侧 NAA/ Cr 小于健侧， Cho/ Cr 大于健侧（P ﹤0.05）。病例组 P300波幅小于对照组，P300潜伏期、RPQ 评分大于对照组（P ﹤0.05）。病例组额叶白质、半卵圆中心患侧的 NAA/ Cr 与 P300波幅呈正相关（r =0.874，P ﹤0.001；r =0.883，P ﹤0.001），与 P300潜伏期（r =-0.813，P ﹤0.001；r =-0.850，P ﹤0.001）、RPQ 评分（ r =-0.617，P ﹤0.001；r =-0.627，P ﹤0.001）均呈负相关；病例组额叶白质、半卵圆中心患侧的 Cho/ Cr 与 P300波幅均呈负相关（r =-0.862，P ﹤0.001；r =-0.749，P ﹤0.001），与 P300潜伏期（r =0.607，P ﹤0.001；r =0.552，P =0.002）、RPQ 评分（r =0.786，P ﹤0.001；r =0.558，P =0.001）均呈正相关。结论 MRS 能从分子层面反映 mTBI 患者伤后脑组织的生化及组织代谢的变化情况，P300能客观地反映 mTBI 患者的认知功能受损情况，RPQ 评分能较客观地反映 mTBI 患者脑震荡后综合征的严重程度，三者结合在 mTBI 的早期诊断、评估及预后中有着重要意义。%Background It is common to see mild traumatic brain injury(mTBI)and emergence of post concussion syndrome seriously troubles the life of patients. Because of relatively subjective clinical manifestations and the not high relevant auxiliary examinations,its current clinical diagnosis remains controversial. It is important to explore the effective detection methods for early diagnosis and prognosis evaluation. Objective To explore the value of magnetic resonance spectroscopy (MRS), event related potentials ( P300 ) and rivermead post concussion symptoms questionnaire ( RPQ ) score in mTBI. Methods According to the inclusion criteria,30 mTBI patients and 30 healthy volunteers after physical examination in Dongguan Tung Wash Hospital from May 2012 to June 2015 were respectively selected as case group and control group. All the subjects were performed with MRI examination,P300 detection and RPQ scores. The levels of metabolites〔 N - acetylaspartate (NAA),creatine(Cr),choline(Cho)〕in the left and right side of basal ganglia,white matter of frontal lobe,semioval center,genu of corpus callosum,and splenium of corporis callosum were measured respectively. NAA/ Cr and Cho/ Cr of affected side and healthy side in the case group,and NAA/ Cr and Cho/ Cr of left side and right side in the control group,amplitude and latency period of P300 and RPQ score of all subjects were recorded. Results The routine MRI examination in the two groups showed no abnormalities. In case group,NAA peak in affected side of white matter of frontal lobe and semioval center declined and Cho peak increased compared with the healthy side. There was no significant difference in NAA/ Cr and Cho/ Cr between left side and right side of basal ganglia,white matter of frontal lobe,semioval center,genu of corpus callosum,splenium of corporis callosum in control group(P ﹥ 0. 05);there was no significant difference in NAA/ Cr and Cho/ Cr between affected side and healthy side of basal ganglia,genu of corpus callosum,splenium of corporis callosum in case group(P ﹥ 0. 05);in case group, NAA/ Cr and Cho/ Cr in affected side of white matter of frontal lobe and semioval center were lower than and higher than those in the healthy side respectively(P ﹤ 0. 05). Amplitude of P300 of case group was less than that of control group,while latency period of P300 and RPQ score were greater than those of control group(P ﹤ 0. 05). In case group,NAA/ Cr in affected side of white matter of frontal lobe and semioval center was positively correlated with amplitude of P300( r = 0. 874,P ﹤ 0. 001;r= 0. 883,P ﹤ 0. 001),while negatively correlated with latency period of P300(r = - 0. 813,P ﹤ 0. 001;r = - 0. 850,P ﹤0. 001)and RPQ score(r = - 0. 617,P ﹤ 0. 001;r = - 0. 627,P ﹤ 0. 001);in case group,Cho/ Cr in affected side of white matter of frontal lobe and semioval center was negatively correlated with amplitude of P300 ( r = - 0. 862,P ﹤ 0. 001;r= - 0. 749,P ﹤ 0. 001),while positively correlated with latency period of P300( r = 0. 607,P ﹤ 0. 001;r = 0. 552,P= 0. 002)and RPQ score(r = 0. 786,P ﹤ 0. 001;r = 0. 558,P = 0. 001). Conclusion MRS can reflect the changes of the biochemical and tissue metabolism of brain tissues of mTBI patients after trauma from the molecular level. P300 can objectively reflect the impaired condition of cognitive function of mTBI patients. RPQ score can objectively reflect the severity of post concussion syndrome of mTBI patients. The combination of the three is important significance in the early diagnosis,evaluation and prognosis of mTBI.
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