Ashwal S, Holshouser B A, Shu S K, Simmons P L, Perkin R M, Tomasi L G, Knierim D S, Sheridan C, Craig K, Andrews G H, Hinshaw D B
Division of Child Neurology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California 92350, USA.
Pediatr Neurol. 2000 Aug;23(2):114-25. doi: 10.1016/s0887-8994(00)00176-4.
We studied 26 infants (1-18 months old) and 27 children (18 months or older) with acute nonaccidental (n = 21) or other forms (n = 32) of traumatic brain injury using clinical rating scales, a 15-point MRI scoring system, and occipital gray matter short-echo proton MRS. We compared the differences between the acutely determined variables (metabolite ratios and the presence of lactate) and 6- to 12-month outcomes. The metabolite ratios were abnormal (lower NAA/Cre or NAA/Cho; higher Cho/Cre) in patients with a poor outcome. Lactate was evident in 91% of infants and 80% of children with poor outcomes; none of the patients with a good outcome had lactate. At best, the clinical variables alone predicted the outcome in 77% of infants and 86% of children, and lactate alone predicted the outcome in 96% of infants and 96% of children. No further improvement in outcome prediction was observed when the lactate variable was combined with MRI ratios or clinical variables. The findings of spectral sampling in areas of brain not directly injured reflected the effects of global metabolic changes. Proton MRS provides objective data early after traumatic brain injury that can improve the ability to predict long-term neurologic outcome.
我们使用临床评分量表、一个15分的MRI评分系统以及枕叶灰质短回波质子磁共振波谱（MRS），对26名婴儿（1至18个月大）和27名儿童（18个月及以上）进行了研究，这些儿童患有急性非意外性（n = 21）或其他形式（n = 32）的创伤性脑损伤。我们比较了急性确定的变量（代谢物比率和乳酸的存在情况）与6至12个月的预后之间的差异。预后不良的患者代谢物比率异常（NAA/Cre或NAA/Cho较低；Cho/Cre较高）。91%的婴儿和80%的预后不良儿童中可见乳酸；预后良好的患者均无乳酸。单独的临床变量最多能在77%的婴儿和86%的儿童中预测预后，单独的乳酸能在96%的婴儿和96%的儿童中预测预后。当将乳酸变量与MRI比率或临床变量结合时，未观察到预后预测有进一步改善。在未直接受伤的脑区进行光谱采样的结果反映了整体代谢变化的影响。质子MRS在创伤性脑损伤后早期提供客观数据，可提高预测长期神经学预后的能力。
