瓦斯爆炸有毒气体中毒后脑部MRI表现及其与创伤后应激障碍的相关性研究
와사폭작유독기체중독후뇌부MRI표현급기여창상후응격장애적상관성연구
MRI findings of the brain after gas explosion and its relationship with post-traumatic stress disorder
  • 万方数据
    中华放射学杂志 중화방사학잡지
    Chinese Journal of Radiology
    2008年 12期 1241-1245 ,共5页

    赵瑞峰%晋记龙%李华兵%李树峰%田树文%李海学%陈雁卉%王天亮%马林%任子敬

    조서봉%진기룡%리화병%리수봉%전수문%리해학%진안훼%왕천량%마림%임자경

    气体中毒%脑损伤%应激障碍,创伤后%磁共振成像 氣體中毒%腦損傷%應激障礙,創傷後%磁共振成像
    기체중독%뇌손상%응격장애,창상후%자공진성상
    Gas poisoning%Brain injuries%Stress disorders,post-traumatic%Magnetic resonance imaging
    目的 动态观察瓦斯爆炸伤后脑部MRI表现及其变化规律,探讨MRI表现与创伤后应激障碍(PTSD)的相关性.方法 选取瓦斯爆炸后幸存者49例(A组)、爆炸当天未下井矿工40名(B组)、地面工作的矿区人员40名(C组).对A组于瓦斯爆炸后1至3 d内进行首次脑部MR检查,并进行多次复查(2、3、6个月及1年),观察病变的影像改变及其信号演变;测量3组海马、苍白球的T2信号强度值,并进行方差分析;对病变组海马、苍白球T2信号强度值及海马ADC值与PTSD的关系进行t检验.结果 A组首次MRI表现:海马(33例)、苍白球(12例)、皮层(10例)及中脑(2例)呈稍长T1长T2异常信号;2个月复查:海马异常信号消失25例,遗留稍长T2信号8例;苍白球3例异常信号消失,余9例苍白球病变范围均缩小呈软化灶改变;受累皮层2例演变为软化灶,余病变恢复正常;脑干呈软化灶改变.A组与B组、C组海马及苍白球的T2信号强度值之间差异均有统计学意义(P值均<0.01),B组与C组海马及苍白球的T2信号强度值之间差异无统计学意义(P值均>0.05);A组PTSD与非PTSD患者首次检查时左侧海马T2信号强度值分别为455±37、462±53,右侧为458±36、460±43;2个月时左侧海马T2信号强度值分别为438±29、424±37,右侧分别为442±31、430±32,差异均无统计学意义(t值分别为0.499、0.193、1.512、1.298,P值均>0.05).A组PTSD与非PTSD患者首次检查时左侧苍白球T2信号强度值分别为361±35、366±63,右侧为363+41、375±62;2个月时左侧苍白球T2信号强度值分别为341±24、337±39,右侧分别为340±26、332±35,差异亦无统计学意义(t值分别为0.350、0.826、0.503、0.907,P值均>0.05).A组PTSD与非PTSD患者首次检查时左侧海马ADC值分别为(8.1±1.1)×10-4、(8.1±0.9)×10-4mm2/s,右侧为(8.2±1.0)×10-4、(8.2±0.8)×10-4mm2/s,差异均无统计学意义(t值分别为0.016、0.081,P值均>0.05);2个月时左侧海马ADC值分别为(8.8±0.7)×10-4、(9.0±1.0)×10-4mm2/s,差异无统计学意义(t=0.333,P>0.05),右侧分别为(8.5±0.9)×10-4、(9.3±1.1)×10-4mm2/s,差异具有统计学意义(t=7.407,P<0.05).结论 海马及苍白球是瓦斯爆炸极易受损的脑区,PTSD的发生可能与右侧海马的损害相关,而与苍白球的损害无关.
    목적 동태관찰와사폭작상후뇌부MRI표현급기변화규률,탐토MRI표현여창상후응격장애(PTSD)적상관성.방법 선취와사폭작후행존자49례(A조)、폭작당천미하정광공40명(B조)、지면공작적광구인원40명(C조).대A조우와사폭작후1지3 d내진행수차뇌부MR검사,병진행다차복사(2、3、6개월급1년),관찰병변적영상개변급기신호연변;측량3조해마、창백구적T2신호강도치,병진행방차분석;대병변조해마、창백구T2신호강도치급해마ADC치여PTSD적관계진행t검험.결과 A조수차MRI표현:해마(33례)、창백구(12례)、피층(10례)급중뇌(2례)정초장T1장T2이상신호;2개월복사:해마이상신호소실25례,유류초장T2신호8례;창백구3례이상신호소실,여9례창백구병변범위균축소정연화조개변;수루피층2례연변위연화조,여병변회복정상;뇌간정연화조개변.A조여B조、C조해마급창백구적T2신호강도치지간차이균유통계학의의(P치균<0.01),B조여C조해마급창백구적T2신호강도치지간차이무통계학의의(P치균>0.05);A조PTSD여비PTSD환자수차검사시좌측해마T2신호강도치분별위455±37、462±53,우측위458±36、460±43;2개월시좌측해마T2신호강도치분별위438±29、424±37,우측분별위442±31、430±32,차이균무통계학의의(t치분별위0.499、0.193、1.512、1.298,P치균>0.05).A조PTSD여비PTSD환자수차검사시좌측창백구T2신호강도치분별위361±35、366±63,우측위363+41、375±62;2개월시좌측창백구T2신호강도치분별위341±24、337±39,우측분별위340±26、332±35,차이역무통계학의의(t치분별위0.350、0.826、0.503、0.907,P치균>0.05).A조PTSD여비PTSD환자수차검사시좌측해마ADC치분별위(8.1±1.1)×10-4、(8.1±0.9)×10-4mm2/s,우측위(8.2±1.0)×10-4、(8.2±0.8)×10-4mm2/s,차이균무통계학의의(t치분별위0.016、0.081,P치균>0.05);2개월시좌측해마ADC치분별위(8.8±0.7)×10-4、(9.0±1.0)×10-4mm2/s,차이무통계학의의(t=0.333,P>0.05),우측분별위(8.5±0.9)×10-4、(9.3±1.1)×10-4mm2/s,차이구유통계학의의(t=7.407,P<0.05).결론 해마급창백구시와사폭작겁역수손적뇌구,PTSD적발생가능여우측해마적손해상관,이여창백구적손해무관.
    Objective To investigate MR findings and dynamic changes of the brain after gas explosion,and to evaluate the relationship between MR findings and post-traumatic stress disorder (PTSD).Methods Forty-nine survivors of a gas explosion (group A) were examined with brain MRI within 1 to 3 days,and serial MR follow-up examinations were also performed.Forty miners not under the ground that day were assigned as group B,and 40 staff working on the ground as group C.The signal intensity values of hippocampus and globus pallidus on T2WI were measured in the three groups and F test was performed by using SPSS 13.0.The relationship between signal intensity values of hippocampus/globns pallidus and PTSD was explored,and the relationship between ADC values of hippocampus and PTSD was also investigated.Results In group A,slight low signal on T1WI and high signal on T2WI were detected on initial MRI in hippocampus (33 cases),globus pallidus (12 cases),cortex (10 cases),and midbrain (2 cases),respectively.On follow-up MRI at 2 months,lesions in hippocampus disappeared (25 cases) or remained slight high signal on T2WI (8 cases),lesions in globus pallidus disappeared (3 cases,5 sides) or showed shrinkage and encephalomalacia (9 cases),cortical lesions resulted in encephalomalacia in 2 cases and returned normal in the others,and lesions in the midbrain showed encephalomatacia.For comparison of T2 signal intensity values in hippocampus and globus pallidus,there was significant difference between group A and group B(P <0.01),and also between group A and group C(P <0.01),but no difference was detected between group B and group C (P>0.05).In group A,the T2 signal intensities of PTSD and non-PTSD were 455±37 and 462±53 in the left hippocarnpus,and 458±36 and 460±43 in the right hippoeampus on 1 to 3 days,and the T2 signal intensities of PTSD and non-PTSD were 438±29 and 424±37 in the left hippocampns,and 442±31 and 430±32 in the right hippocampus at 2 months.The T2 signal intensities of PTSD and non-PTSD were 361 ±35 and 366±63 in the left globus pallidus,and 363 ±41 and 375±62 in the right globus pallidus on 1 to 3 days,and the T2 signal intensities of PTSD and non-PTSD were 341±24 and 337±39 in the left globns pallidus,340±26 and 332±35 in the tight glohus pallidns at 2 months.There was no difference of T2 signal intensity values in hippocampus and globus pallidus between PTSD and non-PTSD( t=0.350,0.826,0.503,0.907,P>0.05).In group A,ADC values of PTSD and nun-PTSD were (8.1±1.1)×10-4 and(8.1 ±0.9)×10-4mm2/s in the left hippocampus,and (8.2±1.0)×10-4 and(8.2±0.8)×10-4mm2/s in the tight hippocampus on 1 to 3 days,ADC values were (8.8±0.7)×10-4 and (9.0±1.0)×10-4mm2/s in the left hippocampus,and (8.5±0.9)×10-4 and (9.3±1.1)×10-4mm2/s in the tight hippocampus at 2 months.ADC values in hippocampns showed no difference between PTSD and non-PTSD(t=0.016,0.081,P>0.05)on initial MRI,but showed significant difference between PTSD and non-PTSD in tight hippocampus (t=7.407,P < 0.05) on follow-up MRI at 2 months,while no difference in left hippocampus (t =0.333,P>0.05) was observed at 2 months.Conclusion Hippocampns and globus pallidus are the most vulnerable structures in gas explosion.The occurrence of PTSD may be related to the injury of fight hippocampus,but not related to the injury of globns pallidus.
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