Department of Neurosurgery, Iwate Medical University, Uchimaru 19-1, Morioka 020-8505, Japan.
J Neurol Neurosurg Psychiatry. 2011 Aug;82(8):869-75. doi: 10.1136/jnnp.2010.222422. Epub 2011 Jan 17.
The authors examined whether (1)H-magnetic resonance spectroscopy (MRS) can identify damage to the centrum semiovale in the subacute phase after CO exposure.
Subjects comprised 29 adult patients who were treated with hyperbaric oxygenation within a range of 4-95 h (mean 18.7 h) after CO exposure. Subjects were classified into three groups according to clinical behaviours: Group A, patients with transit acute symptoms only; Group P, patients with persistent neurological symptoms; and Group D, patients with 'delayed neuropsychiatric sequelae' occurring after a lucid interval. MRS of bilateral centrum semiovale was performed 2 weeks after CO inhalation for all patients and 13 healthy volunteers. The mean ratios of choline-containing compounds/creatine ((mean)Cho/Cr) and N-acetylaspartate/Cr ((mean)NAA/Cr) for bilateral centrum semiovale were calculated and compared between the three CO groups and controls. Myelin basic protein (MBP) concentration in cerebrospinal fluid was examined at 2 weeks to evaluate the degree of demyelination in patients.
MBP concentration was abnormal for almost all patients in Groups P and D, but was not abnormal for any Group A patients. The (mean)Cho/Cr ratios were significantly higher in Groups P and D than in Group A. No significant difference in (mean)NAA/Cr ratio was seen between the three pathological groups and controls. A significant correlation was identified between MBP and (mean)Cho/Cr ratio.
These results suggest that the Cho/Cr ratio in the subacute phase after CO intoxication represents early demyelination in the centrum semiovale, and can predict chronic neurological symptoms.
作者研究了（1）H 磁共振波谱（MRS）是否可以识别 CO 暴露后亚急性期半卵圆中心的损伤。
研究对象包括 29 例成人患者，他们在 CO 暴露后 4-95 小时（平均 18.7 小时）范围内接受高压氧治疗。根据临床行为将患者分为三组：A 组，仅有短暂急性症状的患者；P 组，持续存在神经症状的患者；D 组，在意识清醒期后出现“迟发性神经精神后遗症”的患者。所有患者和 13 名健康志愿者在 CO 吸入后 2 周进行双侧半卵圆中心 MRS。计算双侧半卵圆中心胆碱化合物/肌酸（（mean）Cho/Cr）和 N-乙酰天冬氨酸/肌酸（（mean）NAA/Cr）的平均比值，并与三组 CO 患者和对照组进行比较。在 2 周时检查脑脊液中髓鞘碱性蛋白（MBP）浓度，以评估患者脱髓鞘的程度。
P 组和 D 组几乎所有患者的 MBP 浓度均异常，但 A 组患者的 MBP 浓度均正常。P 组和 D 组的（mean）Cho/Cr 比值明显高于 A 组。三组病理组与对照组的（mean）NAA/Cr 比值无显著差异。MBP 与（mean）Cho/Cr 比值之间存在显著相关性。
这些结果表明，CO 中毒后亚急性期的 Cho/Cr 比值代表半卵圆中心的早期脱髓鞘，并可预测慢性神经症状。
