瞬目反射作为长期意识障碍患者的预后指标：一项前瞻性病例对照研究。

Blink reflex as a prognostic indicator for patients with prolonged disorders of consciousness: a prospective case-control study.

作者信息

Fu Juanjuan, Feng Hui, Pan Huaping, Wu Yongli, Liu Lizhi, Chen Fangyu, Feng Huiyue, Wang Hongxing

机构信息

Department of Rehabilitation Meidicine, Southeast University Zhongda Hospital, Nanjing, Jiangsu, China.

Department of Rehabilitation Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.

出版信息

BMJ Open. 2025 Aug 31;15(8):e099594. doi: 10.1136/bmjopen-2025-099594.

DOI:10.1136/bmjopen-2025-099594

PMID:40887124

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12406912/

Abstract

OBJECTIVE

This study aimed to investigate the characteristics of the blink reflex and its prognostic value for consciousness improvement in patients with prolonged disorders of consciousness (DOC).

DESIGN

Prospective case-control study.

SETTING

This study was conducted in a local hospital between March 2022 and March 2023.

PARTICIPANTS

Patients in a vegetative state/unresponsive wakefulness syndrome or in a minimally conscious state were enrolled within 3 months from their brain injury.

PRIMARY AND SECONDARY OUTCOME MEASURES

The early component (R1), ipsilateral late component (iR2) and contralateral late component (cR2) responses at baseline were recorded using electromyography. The patients' clinical diagnosis and the best Coma Recovery Scale-Revised (CRS-R) total score were assessed based on Chinese CRS-R evaluations.

OUTCOME DEFINITION

At the 6-month follow-up, patients were categorised as improved or non-improved based on CRS-R score changes (improved (transition to a higher consciousness state); non-improved (worsened condition, static or death)).

RESULTS

A total of 58 DOC patients were included in this study. Of the 58 DOC patients, 32 were classified as the improved group and 26 as the non-improved group. In the improved group, R2 responses were elicited in 30 patients, while only 16 patients in the non-improved group had elicited R2 responses. The non-improved group exhibited significantly lower R2 mean amplitudes (iR2 (105.08 µV vs 173.25 µV, p=0.01); cR2 (55.15 µV vs 114.03 µV, p=0.01)) and longer mean latencies (iR2 (41.08±6.72 ms vs 37.77±3.94 ms, p=0.03); cR2 (41.32±6.28 ms vs 37.48±4.07 ms, p=0.01)) compared with the improved group. The result demonstrated that the iR2 mean amplitude (OR=1.01, area under the curve (AUC)=0.78 (95% CI 0.63 to 0.93), sensitivity=78.12%, specificity=83.33%, p=0.02) and cR2 mean amplitude (OR=1.02, AUC=0.76 (95% CI 0.62 to 0.90), sensitivity=81.25%, specificity=72.22%, p=0.02) were significant predictors of consciousness improvement. Meanwhile, Pearson correlation analysis revealed that iR2 mean amplitude (r=0.42, p=0.003) and cR2 mean amplitude (r=0.53, p=0.001) significantly correlated with CRS-R score at baseline.

CONCLUSION

The R2 amplitude in patients with prolonged DOC may serve as a prognostic indicator for consciousness improvement.

摘要

目的

本研究旨在探讨长期意识障碍（DOC）患者的眨眼反射特征及其对意识改善的预后价值。

设计

前瞻性病例对照研究。

地点

本研究于2022年3月至2023年3月在当地一家医院进行。

参与者

植物状态/无反应觉醒综合征或最低意识状态的患者在脑损伤后3个月内入组。

主要和次要观察指标

使用肌电图记录基线时的早期成分（R1）、同侧晚期成分（iR2）和对侧晚期成分（cR2）反应。根据中国昏迷恢复量表修订版（CRS-R）评估患者的临床诊断和最佳CRS-R总分。

结果定义

在6个月的随访中，根据CRS-R评分变化（改善（转变为更高意识状态）；未改善（病情恶化、静止或死亡））将患者分为改善组或未改善组。

结果

本研究共纳入58例DOC患者。在这58例DOC患者中，32例被分类为改善组，26例为未改善组。在改善组中，30例患者引出了R2反应，而未改善组中只有16例患者引出了R2反应。与改善组相比，未改善组的R2平均波幅显著更低（iR2（105.08μV对173.25μV，p = 0.01）；cR2（55.15μV对114.03μV，p = 0.）），平均潜伏期更长（iR2（41.08±6.72ms对37.77±3.），p = 0.03）；cR2（41.32±6.28ms对37.48±4.），p = 0.01）。结果表明，iR2平均波幅（OR = 1.01，曲线下面积（AUC）= 0.78（95%CI 0.63至0.93），敏感性 = 78.12%，特异性 = 83.33%，p = 0.02）和cR2平均波幅（OR = 1.02，AUC = 0.76（95%CI 0.62至0.90），敏感性 = 81.25%，特异性 = 72.22%，p =）是意识改善的显著预测指标。同时，Pearson相关性分析显示，iR2平均波幅（r = 0.42，p = 0.003）和cR2平均波幅（r = 0.53，p = 0.001）与基线时的CRS-R评分显著相关。