缺氧缺血性脑损伤后植物状态患者的脑代谢：F-18 氟脱氧葡萄糖正电子发射断层扫描的统计参数映射分析。

Brain metabolism in patients with vegetative state after post-resuscitated hypoxic-ischemic brain injury: statistical parametric mapping analysis of F-18 fluorodeoxyglucose positron emission tomography.

机构信息

Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

Chin Med J (Engl). 2013 Mar;126(5):888-94.

PMID:23489797

Abstract

BACKGROUND

Hypoxic-ischemic brain injury (HIBI) after cardiopulmonary resuscitation is one of the most devastating neurological conditions that causing the impaired consciousness. However, there were few studies investigated the changes of brain metabolism in patients with vegetative state (VS) after post-resuscitated HIBI. This study aimed to analyze the change of overall brain metabolism and elucidated the brain area correlated with the level of consciousness (LOC) in patients with VS after post-resuscitated HIBI.

METHODS

We consecutively enrolled 17 patients with VS after HIBI, who experienced cardiopulmonary resuscitation. Overall brain metabolism was measured by F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) and we compared regional brain metabolic patterns from 17 patients with those from 15 normal controls using voxel-by-voxel based statistical parametric mapping analysis. Additionally, we correlated the LOC measured by the JFK-coma recovery scale-revised of each patient with brain metabolism by covariance analysis.

RESULTS

Compared with normal controls, the patients with VS after post-resuscitated HIBI revealed significantly decreased brain metabolism in bilateral precuneus, bilateral posterior cingulate gyrus, bilateral middle frontal gyri, bilateral superior parietal gyri, bilateral middle occipital gyri, bilateral precentral gyri (PFEW correctecd < 0.0001), and increased brain metabolism in bilateral insula, bilateral cerebella, and the brainstem (PFEW correctecd < 0.0001). In covariance analysis, the LOC was significantly correlated with brain metabolism in bilateral fusiform and superior temporal gyri (Puncorrected < 0.005).

CONCLUSIONS

Our study demonstrated that the precuneus, the posterior cingulate area and the frontoparietal cortex, which is a component of neural correlate for consciousness, may be relevant structure for impaired consciousness in patient with VS after post-resuscitated HIBI. In post-resuscitated HIBI, measurement of brain metabolism using PET images may be helpful for investigating the brain function that cannot be obtained by morphological imaging and can be used to assess the brain area responsible for consciousness.

摘要

背景

心肺复苏后缺氧缺血性脑损伤（HIBI）是导致意识障碍的最具破坏性的神经疾病之一。然而，很少有研究调查心肺复苏后 HIBI 后植物状态（VS）患者的脑代谢变化。本研究旨在分析整体脑代谢的变化，并阐明与 VS 患者意识水平（LOC）相关的脑区。

方法

我们连续纳入了 17 例心肺复苏后 HIBI 后出现 VS 的患者。通过 F-18 氟脱氧葡萄糖正电子发射断层扫描（F-18 FDG PET）测量整体脑代谢，并通过体素基统计参数映射分析比较 17 例患者与 15 例正常对照的局部脑代谢模式。此外，我们通过协方差分析将每位患者的 JFK 昏迷恢复量表修订版测量的 LOC 与脑代谢相关联。

结果

与正常对照组相比，心肺复苏后 HIBI 后出现 VS 的患者双侧楔前叶、双侧后扣带回、双侧额中回、双侧顶上回、双侧中颞回、双侧中央前回的脑代谢明显降低（PFEW 校正<0.0001），双侧岛叶、双侧小脑和脑干的脑代谢明显升高（PFEW 校正<0.0001）。协方差分析显示，LOC 与双侧梭状回和颞上回的脑代谢显著相关（未校正 P<0.005）。