目的 通过质子磁共振波谱(1H-proton magnetic resonance spectroscopy,1 H-MRS)研究原发性脑干损伤(primary brain stem injury,PBSI)患者局部神经异常代谢状态及其与预后的关系.方法 36例PBSI患者在伤后3 h～16天行1H-MRS检测,分析伤后神经代谢物的变化特征,并与12名健康志愿者(对照组)进行比较.采用直线回归分析患者1H-MRS值和临床指标与伤后6个月格拉斯哥预后评分(Glasgow outcome score,GOS)的相关性.结果 与对照组相比,PBSI患者桥脑腹侧NAA/Cr和NAA/Cho值下降,Cho/Cr值升高(P＜0.05),且随伤情加重表现更加明显.预后不良患者的NAA/Cr和NAA/Cho值低于预后良好的患者(P＜0.05)；损伤组NAA值的变化与GOS呈显著正相关(r=0.79,P＜0.05)；Cho/NAA值与GOS呈显著负相关(r= -0.65,P＜0.05).结论 PBSI患者在伤后早期进行1H-MRS检测对评估损伤严重程度和预后有重要价值.%Objective To observe the focal neurological metabolic abnormalities and its relationship with the prognosis in patients with primary brain stem injury (PBSI) by proton magnetic resonance spectroscopy (1H-MRS). Methods Thirty-six PBSI patients were enrolled as study group underwent 'H-MRS between 3 hours and 16 days after injury. Twelve volunteers were enrolled as control group.Linear regression analysis was used to assess the correlation between 1H-MRS value and clinical index and Glasgow outcome score (GOS) 6 months after injury. Results Compared with controls,ventral pontine NAA/Cr and NAA/Cho values decreased, and Cho/Cr value increased (P < 0.05)in PBSZ patient ,and the difference got more obvious as injury aggravated. Patients with poor prognosis had lower NAA/Cr and NAA/Cho values than those with favourable prognosis (P<0.05). In study group, NAA and GOS was positively correlated ( r = 0.79, P<0.05), while Cho/NAA and GOS was negatively correlated (r = -0.65, P<0.05). Conclusions Analysis of 1H-MRS in PBSI patients at the early stage was useful in evaluating the severity of injury and prognosis.
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