Brain:儿童创伤性脑损伤后的脑容量异常和临床结果

2022-08-04 brainnew神内神外 网络

研究者的结果表明了儿童创伤性脑损伤后的脑容量异常是如何通过使用大型规范数据集(允许对健康大脑发育的影响进行控制),从个体水平的T1像MRI中可靠地计算出来的。

儿童创伤性脑损伤的长期预后很难预测。局灶性脑损伤是否存在通常不能解释常见的认知、情感和行为障碍。在成年人中,创伤性脑损伤会产生进行性脑萎缩,可以准确测量,并与认知能力下降有关。然而,由于儿童创伤性脑损伤与正常大脑发育的相互作用,其对脑容量的影响更难测量。近日,来自英国帝国理工学院的Niall J. Bourke团队在《Brain》杂志上发表了题为“Brain volume abnormalities and clinical outcomes following paediatric traumatic brain injury”的文章,报告了一种可靠的方法来评估儿童创伤性脑损伤后的脑容量,并研究了这种方法与临床结果的关系。

研究结果

研究者首先使用大型健康被试数据集(n >1200,8-22岁)来描述白质和灰质区域在青春期的发育情况。然后,通过比较儿童时期受伤的一组中/重度创伤性脑损伤患者(n = 39,平均年龄13.53 ± 1.76,受伤后的中位时间为14个月,范围为4-168个月)与年龄匹配的对照组的脑容量,对脑灰质和白质区域体积进行个体估计(图 1所示)。研究者将患者分为脑容量低或正常的两组,采用标准化测试和父母/照顾者评估来评价神经心理学和神经精神病学结果。

图1: 研究流程图。使用SPM12 VBM处理模块对人群和研究的MRI数据进行预处理。在19个样本数据扫描站点中随机选择了一个具有代表性的参与者样本来创建一个青少年模板。局灶性病变患者绘制的掩码被排除在感兴趣区域(ROI)估计之外。对于每个感兴趣的区域,计算年龄的平均值和标准差(SD)。使用一组独立的儿科TBI数据,对这些标准评估进行个体比较。

相对于头部大小,在正常青春期发育期间灰质区域体积减少,而白质束体积增加。创伤性脑损伤破坏了健康的大脑发育,在校正年龄后,脑灰质和白质体积都有所减少(如图2所示)。在39例被研究的患者中,11例(28%)至少有一个白质束体积减小,7例(18%)至少有一个灰质区体积减小。与健康对照组相比,那些被归类为脑容量较低的人处理信息的速度较慢,情感受损,更冷漠,易怒和学习困难增加;而局灶性脑损伤和微出血的存在与这些临床损伤的风险增加无关。

图2:Voxel-wise体积分析(局部研究参与者)。(A)蓝绿色热图=与对照组相比,TBI患者的白质减少的区域;红黄热图=与对照组相比,TBI患者脑灰质减少的区域。(B) Hammersmith医院的研究组TICV校正灰质和白质随年龄变化图。校正了年龄、颅内体积、病灶区域的体素(TFCE: P< 0.05,经多重比较校正)。

综上所述,研究者的结果表明了儿童创伤性脑损伤后的脑容量异常是如何通过使用大型规范数据集(允许对健康大脑发育的影响进行控制),从个体水平的T1像MRI中可靠地计算出来的。通过这种方法,研究者发现中度/重度脑损伤后灰质和白质区域的容量异常都很常见,并且与儿童脑损伤后常见的高级认知功能、情绪和行为异常相关。这种新的个性化方法解决了由于年龄导致的巨大差异导致评估损伤对青少年脑容量影响的重要方法问题。同时,个性化的容量评估方法还提供了对儿童创伤性损伤后相关认知功能的一些理解。和其他临床工具一起使用,特定年龄容量估计可以帮助我们更好得了解个例的损伤情况。

参考文献

Bourke, N. J., Demarchi, C., De Simoni, S., Samra, R., Patel, M. C., Kuczynski, A., ... & Sharp, D. J. (2022). Brain volume abnormalities and clinical outcomes following paediatric traumatic brain injury. Brain.

编译作者:ChloeFu(brainnews创作团队)

校审:Charlie Brown(brainnews编辑部)

来源:brainnew神内神外

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    2022-08-06 aids218

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创伤性脑损伤 (TBI) 的严重程度在临床上分为轻度、中度或重度,传统上基于急性意识改变的临床测量和影像学发现。本研究使用了国防部/退伍军人管理局对 TBI 严重程度的定义。轻度至中度 TBI (mm

JNNP:创伤性脑损伤后残疾与报告健康生活质量之间的差异

中度和重度创伤性脑损伤(TBI)后残疾很常见,并且越来越多地被认为是轻度TBI的后果。在TBI之后,个人经常会在生活的不同方面遇到障碍,包括身体、社会和认知方面的限制,这可能会影响他们的福祉。健康的人

Neurology:血浆 p-tau181和 p-tau217在有或没有阿兹海默病病理证据的创伤性脑病综合征患者中的表达

血浆P-tau181和P-tau217可能是鉴定创伤性脑病综合征(TES)中AD病理的一种可行的生物标志物。较低的血浆P-Tau水平可用于增加临床怀疑CTE而不是AD作为TES的主要病理改变。

JAMA Neurol-认知行为疗法,可有效治疗创伤后应激

CBT治疗头痛对退伍军人创伤后头痛相关的残疾有疗效

Eur Rev Med Pharmacol Sci:老年人创伤性脑损伤前服用VK拮抗剂或DOACs是否会影响其结局?

创伤性脑损伤(TBI)是全世界发病和死亡的一个常见原因,老年人中常见TBI。