Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea.
BMC Neurol. 2020 Oct 14;20(1):375. doi: 10.1186/s12883-020-01942-7.
We investigated the relationship between consciousness and the ascending reticular activating system (ARAS) by using diffusion tensor tractography (DTT) in patients with traumatic brain injury (TBI).
Twenty-six patients with TBI and 13 healthy control subjects were recruited for this study. Glasgow Coma Scale (GCS) scores were used for evaluation of subject consciousness state at the chronic stage of TBI (at DTT scanning), According to the GCS score, the patient group was divided into two subgroups: A (14 patients;impaired consciousness: GCS score < 15, and B (12 patients;intact consciousness;GCS score = 15). Fractional anisotropy (FA) and tract volume (TV) values were assessed in the lower dorsal and upper ARAS.
The FA values of the lower dorsal ARAS and the upper ARAS in patient subgroup A were significantly lower than those in patient subgroup B and the control group(p < 0.05). However, the FA and TV values for the lower dorsal ARAS and the upper ARAS were not significantly different between patient subgroup B and the control group(p > 0.05). The FA value of the lower dorsal ARAS(r = 0.473,p < 0.05) and the TV of upper ARAS(r = 0.484,p < 0.05) had moderate positive correlations with the GCS score. The FA value of the upper ARAS had a strong positive correlation with the GCS score of the patient group(r = 0.780,p < 0.05).
We detected a close relationship between consciousness at the chronic stage of TBI and injuries of the lower dorsal and upper ARAS (especially, the upper ARAS) in patients who showed impaired consciousness at the onset of TBI. We believe that our results can be useful during the development of therapeutic strategies for patients with impaired consciousness following TBI.
YUMC 2019-06-032-003 . Retrospectively registered 06 Jun 2020.
我们通过扩散张量纤维束成像（DTT）研究了创伤性脑损伤（TBI）患者意识与上行网状激活系统（ARAS）之间的关系。
本研究纳入了 26 例 TBI 患者和 13 例健康对照者。格拉斯哥昏迷量表（GCS）评分用于评估 TBI 慢性期（DTT 扫描时）患者的意识状态。根据 GCS 评分，患者组分为两组：A 组（14 例；意识障碍：GCS 评分<15）和 B 组（12 例；意识完整：GCS 评分=15）。评估下背侧和上 ARAS 的各向异性分数（FA）和束流容积（TV）值。
A 组患者下背侧 ARAS 和上 ARAS 的 FA 值明显低于 B 组患者和对照组（p<0.05）。然而，B 组患者和对照组之间下背侧 ARAS 和上 ARAS 的 FA 和 TV 值无显著差异（p>0.05）。下背侧 ARAS 的 FA 值（r=0.473，p<0.05）和上 ARAS 的 TV 值（r=0.484，p<0.05）与 GCS 评分呈中度正相关。上 ARAS 的 FA 值与患者组的 GCS 评分呈强正相关（r=0.780，p<0.05）。
我们发现 TBI 慢性期意识与损伤的下背侧和上 ARAS（尤其是上 ARAS）之间存在密切关系，这在 TBI 发病时意识障碍的患者中表现明显。我们相信，我们的研究结果在制定 TBI 后意识障碍患者的治疗策略方面具有重要意义。
YUMC 2019-06-032-003，2020 年 6 月 6 日回顾性注册。
