Department of Neurosurgery, Department of Medicine, St. Luke’s International Hospital, Tokyo, Japan.
J Neurosurg. 2011 Nov;115(5):1019-24. doi: 10.3171/2011.6.JNS11513. Epub 2011 Jul 22.
Previous studies have shown a relationship between a patient's stage of diffuse axonal injury (DAI) and outcome. However, few studies have assessed whether a specific lesion or type of corpus callosum injury (CCI) influences outcome in patients with DAI. The authors investigated the effect of various DAIs and CCIs on outcome in patients with traumatic brain injury (TBI).
The authors retrospectively reviewed 78 consecutive patients with DAI who were seen between May 2004 and March 2010. Outcome was evaluated using the Extended Glasgow Outcome Scale (EGOS) 1 year after TBI. Patients with single DAIs had only 1 of the 3 lesions (lobar, CC, or brainstem). Patients with dual DAIs had 2 of these lesions, and those with triple DAIs had all of these lesions. Furthermore, the authors defined single, dual, and triple CCIs by using 3 lesions (genu, body, splenium) in the same way among patients with single (CC) DAIs. Univariate and multivariate logistic regression analyses were performed to evaluate the relationships between these lesions and outcome in patients with DAI.
Fifty patients had single DAIs: 34 in the lobar area, 11 in the CC, and 5 in the brainstem. Twenty had dual DAIs, and 8 had triple DAIs. Of the 11 CCIs, 9 were single and 2 were dual CCIs. Among these lesions, only those in the genu were related to disability. The authors dichotomized patients into those with and without genu lesions, regardless of other injuries. Multinomial logistic regression analysis showed that a genu lesion (OR 18, 95% CI 2.2-32; p = 0.0021) and a pupillary abnormality (OR 14, 95% CI 1.6-24; p = 0.0068) were associated with disability (EGOS ≤ 6) in patients with DAI.
Regardless of the number of lesions, the existence of a genu lesion suggested disability 1 year after TBI in patients with DAI.
既往研究显示，患者弥漫性轴索损伤（DAI）分期与预后相关。然而，鲜有研究评估特定损伤或胼胝体损伤（CCI）类型是否影响 DAI 患者的预后。作者旨在探讨不同 DAI 和 CCI 对创伤性脑损伤（TBI）患者预后的影响。
作者回顾性分析了 2004 年 5 月至 2010 年 3 月间收治的 78 例 DAI 连续患者。采用格拉斯哥预后量表（EGOS）于 TBI 后 1 年评估预后。单纯 DAI 患者仅存在 3 种病变中的 1 种（大脑半球、胼胝体或脑干）。双 DAI 患者存在 2 种病变，三 DAI 患者存在全部 3 种病变。此外，对于单纯 DAI 患者，作者采用相同方法将 3 种病变（膝部、体部、压部）定义为单纯、双和三 CCI。采用单变量和多变量逻辑回归分析评估 DAI 患者中这些病变与预后的关系。
50 例患者存在单纯 DAI：34 例大脑半球、11 例胼胝体、5 例脑干。20 例存在双 DAI，8 例存在三 DAI。11 例 CCI 中，9 例为单纯病变，2 例为双 CCI。这些病变中，仅膝部病变与残疾相关。作者将患者分为存在和不存在膝部病变两组，而不论其他损伤。多项逻辑回归分析显示，膝部病变（比值比 18，95%置信区间 2.2-32；p = 0.0021）和瞳孔异常（比值比 14，95%置信区间 1.6-24；p = 0.0068）与 DAI 患者的残疾（EGOS≤6）相关。
无论病变数量如何，存在膝部病变提示 DAI 患者 TBI 后 1 年存在残疾。
