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首页> 外文期刊>Journal of Neurology, Neurosurgery and Psychiatry >Acute metabolic brain changes following traumatic brain injury and their relevance to clinical severity and outcome.
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Acute metabolic brain changes following traumatic brain injury and their relevance to clinical severity and outcome.

机译：颅脑外伤后急性代谢性脑部改变及其与临床严重性和预后的关系。

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BACKGROUND: Conventional MRI can provide critical information for care of patients with traumatic brain injury (TBI), but MRI abnormalities rarely correlate to clinical severity and outcome. Previous magnetic resonance spectroscopy studies have reported clinically relevant brain metabolic changes in patients with TBI. However, these changes were often assessed a few to several days after the trauma, with a consequent variation of the metabolic pattern due to temporal changes. METHODS: Proton magnetic resonance spectroscopic imaging (1H-MRSI) examinations were performed in 10 patients with TBI 48-72 h after the trauma, to obtain early measurements of central brain levels of N-acetylaspartate (NAA), choline (Cho), creatine (Cr) and lactate (La). Metabolite values were expressed as ratios to (1) a metabolic pattern, given by the sum of the resonance intensities of all metabolites detected in the same voxel and (2) intravoxel Cr. RESULTS: NAA ratios were found to be significantly lower in patients with TBIthan in normal controls. In contrast, Cho ratios were significantly higher in patients with TBI than in normal controls. Increased La levels were found in 5 of 10 patients with TBI. Both NAA and La values correlated closely with those of the Glasgow Coma Scale at presentation (r = 0.73 and -0.62, respectively; p<0.01 for both) and the Glasgow Outcome Scale at 3 months (r = -0.79 and 0.79, respectively; p<0.01 for both). CONCLUSION: Spectroscopic measures of neuro-axonal damage occurring soon after a brain trauma are clinically relevant. Significant increases in cerebral La level also may be detected when 1H-MRSI is performed early after the trauma and, at this stage, can represent a reliable index of injury severity and disease outcome in patients with TBI.
机译：背景：常规MRI可以为颅脑外伤（TBI）患者的护理提供关键信息，但MRI异常很少与临床严重程度和预后相关。先前的磁共振波谱研究已经报告了TBI患者临床相关的脑代谢变化。但是，这些变化通常是在创伤后数天到数天进行评估的，其结果是由于时间变化而导致的代谢模式发生变化。方法：对创伤后48-72 h的10例TBI患者进行质子磁共振波谱成像（1H-MRSI）检查，以早期测定N-乙酰天门冬氨酸（NAA），胆碱（Cho），肌酸的中央脑水平（Cr）和乳酸（La）。代谢物值表示为与（1）代谢模式的比率，该比率由在同一体素中检测到的所有代谢物的共振强度与（2）内部体素Cr的共振强度之和给出。结果：发现TBI患者的NAA比明显低于正常对照。相反，TBI患者的Cho比明显高于正常对照。在10例TBI患者中有5例发现La水平升高。呈现时的NAA和La值均与格拉斯哥昏迷量表（分别为r = 0.73和-0.62;两者均p <0.01）和3个月时的格拉斯哥成果量表（r分别为-0.79和0.79）密切相关。两者均p ＜0.01）。结论：脑外伤后不久发生的神经-轴突损伤的光谱测量在临床上是相关的。当在创伤后早期进行1H-MRSI时，也可能检测到脑La水平的显着升高，在此阶段，可以代表TBI患者的损伤严重程度和疾病结局的可靠指标。

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