[1]杨艺,宋明,党圆圆,等.合并阵发性交感神经过度兴奋综合征的意识障碍患者脑部结构特征的研究[J].临床神经外科杂志,2020,17(01):16-21.[doi:DOI:10.3969/j.issn.1672-7770.2020.01.005]
 YANG Yi,SONG Ming,DANG Yuan-yuan,et al.Study on structural characteristics of brain in patients with consciousness disorder of paroxysmal sympathetic hyperexcitation syndrome[J].Journal of Clinical Neurosurgery,2020,17(01):16-21.[doi:DOI:10.3969/j.issn.1672-7770.2020.01.005]
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合并阵发性交感神经过度兴奋综合征的意识障碍患者脑部结构特征的研究()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
17
期数:
2020年01期
页码:
16-21
栏目:
意识障碍专题
出版日期:
2020-02-15

文章信息/Info

Title:
Study on structural characteristics of brain in patients with consciousness disorder of paroxysmal sympathetic hyperexcitation syndrome
文章编号:
202001005
作者:
杨艺宋明党圆圆夏小雨耿小丽陈雪玲何江弘赵继宗
100050 北京,首都医科大学附属北京天坛医院神经外科(杨艺,赵继宗);中国科学院自动化所脑网络组学实验室(宋明);解放军总医院第七医学中心神经外科(党圆圆,夏小雨,耿小丽,陈雪玲,何江弘);国家神经系统疾病临床研究中心(赵继宗)
Author(s):
YANG Yi SONG Ming DANG Yuan-yuan et al.
Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China
关键词:
意识障碍交感神经过度兴奋综合征脑结构脑干丘脑
Keywords:
disorders of consciousness sympathetic hyperexcitation syndrome brain structure brainstem thalamus
分类号:
R651
DOI:
DOI:10.3969/j.issn.1672-7770.2020.01.005
文献标志码:
A
摘要:
目的研究阵发性交感神经过度兴奋综合征(paroxysmal sympathetic hyperactivity,PSH)患者在颅脑结构方面的特征性表现,描画PSH症状患者的特殊脑部结构变化;从而探索性阐述PSH发生的可能区域及机制。方法选择解放军总医院第七医学中心神经外科2018年1月—2018年12月收治的意识障碍 (disorders of consciousness,DOC)患者共51例,经过筛选,入组患者34例。其中合并PSH及无合并PSH的患者各17例,分为两组。选用在容积分析菜单普通模式下的多模式节段分割命令,完成初期图像分割,采用手工分割方法在所有能够显示丘脑及脑干的MRI层面上描绘出核团轮廓线,测量比较两组脑干和丘脑体积。结果PSH组患者的脑干体积略大,两组患者的脑干体积差异有统计学意义(P=0.034)。PSH组与无PSH组相比右侧丘脑体积偏小,为(6 082.1±1 034.1)mm3,两组差异有统计学意义(P=0.019)。而左侧丘脑体积,PSH组偏大,为(7 972.7±2 063.9)mm3,两组的差异有统计学意义(P=0.025)。两组不同患者的PSH联合评分与6个月后昏迷恢复量表修订版(coma recovery scale-revised,CSR-R)评分呈正相关。结论右侧丘脑损伤的DOC患者更容易发生PSH,长期的PSH发作可能会对脑干及丘脑结构的损伤有一定的影响。慢性DOC患者的PSH症状出现可能提示更好的意识预后,在合理控制PSH发作的情况下,其意识水平恢复可能具有更好的潜力。
Abstract:
Objective To observe the characteristic features of brain structure of patients with paroxysmal sympathetic hyperactivity(PSH) symptoms and to describe the special brain structure changes of patients with PSH symptoms,so as to explore the possible regions and mechanisms of PSH occurrence. MethodsA total of 51 disorders of consciousness(DOC) patients were selected from January 2018 to June 2018 in the Department of Neurosurgery, the 7th Medical Center of PLA General Hospital. After screening, 34 patients were enrolled, and 17 patients with and without PSH were divided into two groups. The multi-mode segment segmentation command under the normal mode of the volume analysis menu was selected to complete the initial image segmentation. The manual segmentation method was used to draw the contour lines of the nucleus on all MRI planes capable of displaying thalamus and brainstem. The volume of brainstem and thalamus of the two groups were compared with the image information of corresponding axial scanning for the part that was difficult to identify. ResultsThe brainstem volume of patients in PSH group was slightly larger than that of patients in PSH group. The difference in brainstem volume between the two groups was statistically significant(P=0.034). The volume of right thalamus in PSH group was(6 082.1±1 034.1)mm3 smaller than(6 206.6±2 137.3)mm3 in group without PSH. The difference between the two groups was statistically significant(P=0.019). The left thalamus volume was(7 972.7±2 063.9)mm3 in PSH group and(6 538.5±1 420.4)mm3 in non-PSH group. The difference between the two groups was statistically significant(P=0.025). ConclusionsThe unconnected theory is verified, suggesting that the proposed brain stem and thalamus injury will cause PSH attack. Similarly,the excitation-inhibition rate model theory can explain that long-term PSH attack may have certain influence on the brain stem and thalamus injury structure.

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备注/Memo

备注/Memo:
【作者简介】杨艺,首都医科大学附属北京天坛医院主治医师,北京大学医学部八年制医学博士,主要从事昏迷促醒、意识障碍手术及神经调控治疗,脑外伤及外伤后遗症治疗,肌张力障碍、认知障碍及其他功能神经外科疾病的治疗。北京市科技新星,近5年主持国防科技创新课题,国自然青年项目,北京自然青年项目,全军医学科技青年项目,等7项基金,主要参与项目12项。以第一作者(及共同第一)发表SCI 7篇,中文核心15篇;以第二及其他作者发表中文文章三十余篇,SCI十余篇。主译《意识障碍:脑功能与响应性》,副主译《昏迷与意识障碍》,参编参译专业书籍9本。担任中国医师协会神经损伤与修复分会脑网络学组副主委,中国神经科学学会神经损伤与修复分会委员,北京医师协会神经损伤与修复分会慢性意识障碍学组委员,中国研究型医院学会神经再生与修复专委会脑认知与神经调控学组委员;中国神经科学学会意识与意识障碍分会秘书。
更新日期/Last Update: 2020-02-18