JNNP:组织桥接预测脊髓损伤后出现神经性疼痛

2020-08-15 MedSci原创 MedSci原创

脊髓损伤(SCI)是毁灭性的并且改变生活的事件。在大多数情况下,它会在伤害水平以下产生立即和永久的感觉,运动和自主神经功能障碍,从而降低生活质量。除功能缺陷外,大多数患者会出现神经性疼痛(NP)。 N

脊髓损伤(SCI)是毁灭性的并且改变生活的事件。在大多数情况下,它会在伤害水平以下产生立即和永久的感觉,运动和自主神经功能障碍,从而降低生活质量。除功能缺陷外,大多数患者会出现神经性疼痛(NP)。 NP通常在SCI发生后早期出现,通常难以治疗,并且通常持续数年,并且强度可能不断增加。尽管NP的起源尚不清楚,但据认为是保留在髓内病变腔附近的组织桥的原因。重要的是,低于损伤水平的NP会随着时间的推移而发展。 这表明,随着时间的流逝,保留的组织桥中的感觉途径的一部分会变得活跃。有趣的是,SCI患者的脊髓丘脑束功能的恢复得到了增强。患有NP及其严重程度与疼痛强度有关。这项研究旨在探讨从常规T2加权(T2w)连续扫描获得的的矢状中矢状组织桥(腹侧和背侧)在预测SCI相关NP的出现和维持中的价值。因此,作者研究了腹侧和背侧组织桥的宽度与疼痛强度之间的关系及其临床特征。

方法:在这项回顾性研究中,共有44例亚急性SCI患者(28例四肢瘫痪和16例截瘫患者),这些患者在1996年5月至2019年1月期间连续入选Balgrist大学医院(瑞士苏黎世)。在这44例患者中,所有患者均得到随访 SCI后12个月进行的临床评估和32例神经影像学随访。使用来自这些患者的1个月和12个月的神经影像学检查,神经病理性疼痛和临床数据,通过回归分析和无偏递归分区(URP)来调查组差异和临床病理关系以及结果预测。 感兴趣的变量包括病变参数,疼痛以及在1个月和12个月的随访中的临床结局指标。在EMSCI调查表上,患者对疼痛的各个方面进行评分(例如,当前的疼痛强度,评估前最后一周的平均和最大疼痛强度,疼痛的位置和质量,异常性疼痛和感觉异常的强度)。使用11点数字评分量表对疼痛强度进行量化,“ 0”表示无疼痛,“ 10”表示可想象的最严重疼痛。来自EMSCI疼痛调查表的数据可用于43例SCI术后1个月的SCI患者(24例NP,19例无痛患者)和42例SCI术后12个月的患者(28例NP,14例无痛患者)。分别在1个月和12个月时有1例患者和2例没有EMSCI疼痛调查表的患者报告患有NP。所有研究参与者均在1.5或3 T飞利浦(Philips Healthcare,Best,荷兰),西门子(Siemens Healthcare,Erlangen,德国)或GE(GE Medical Systems,Waukesha,Wisconsin,USA)扫描仪上进行了MRI。

结果:四十四名SCI患者(n = 35名男性(79.5%)),平均(±SD)年龄为50.05±18.88岁。 NP患者(50.40±17.38岁,n = 25)和无痛患者(49.58±21.17岁,n = 19)在1个月时年龄无差异(Δmean= -0.82,95%CI −12.55至10.91 ,p = 0.888)。患者受伤至1个月扫描(即亚急性期)之间的时间间隔为32.95±16.85天。 NP患者(30.88±17.55天,n = 25)与无痛患者(35.68±15.93天)受伤后的时间无差异(Δmean= 4.80,95%CI −5.56至15.17,p = 0.355), n = 19)。有6名最初无疼痛的患者出现了NP。 NP在1个月(56.8%)和12个月随访(68.2%)的患者报告的平均NP强度分别为3.67±1.611.6和3.68±1.61(Δmean= 0.01,95%CI -0.89至0.91,p = 0.979 ) 分别。 NP的SCI患者在1个月时的针刺评分为70.08±28.40,在SCI后12个月时的针刺评分为80.16±27.88(Δmean= 10.08,95%CI 2.66至17.50,p = 0.010,n = 25)。在无痛患者中,1个月针刺评分为57.84±25.02,且随时间变化无明显变化(随访时为60.58±27.25(Δmean= 2.74,95%CI -7.36至12.84,p = 0.576,n = 19))。在两个患者组之间,在1个月时的针刺得分无差异(Δ中位数= 15.00,95%CI -7.00至29.00,p = 0.184),从1个月到随访的针刺得分变化率无差异。在12个月时无变化(Δ中位数= 3.00,95%CI -3.00至12.00,p = 0.286)。

这项研究确定了备用的组织桥作为通过常规MRI评估可预测的NP出现和维持的可量化的神经影像生物标记。具体来说,确定了腹侧组织桥的1个月宽度是SCI后12个月时NP强度和针刺评分的最强预测指标。因此,腹侧组织桥代表了MRI指标,可以在日常临床程序中轻松实施,以作为可靠且省时的神经影像生物标记物,用于监测NP并在介入性临床试验中对患者亚组进行分层。

Pfyffer DVallotton KCurt A, et al Tissue bridges predict neuropathic pain emergence after spinal cord injury

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    2020-08-16 lyjjason

    不错👍好好研究

    0

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    2020-08-16 用户被禁用

    好文章,不错!

    0

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近10年来,随着超声和MRI的普遍使用,儿科急诊中CT的使用逐渐下降,但不同机构间非辐射成像方式与CT使用率间的差异显著,建立相应的临床实践标准十分必要

Ann Rheum Dis:未生育、产后早期和晚期女性骶髂关节骨髓水肿的患病率

EPP组SIJ的BME患病率高于NP。与LPP相比,EPP的BME患病率更高,并且BME随着分娩时间的延长而减少。

Stroke:人到中年,那些因素会影响着认知功能呢?

目前中年人群隐匿性血管性脑损伤与认知损伤间关系尚不明确。本研究旨在验证是否具有脑血管风险指标的隐匿性血管性脑损伤患者的认知评分会更低?

Acta Neuropathologic:从大脑弥散性MRI评判朊病毒传播在散发性克雅氏病的依赖性

散发性克雅氏病 (sCJD)是一种可传播的脑蛋白病。当前区分了五种主要的临床病理亚型(sCJD-MM(V)1, -MM(V)2C, -MV2K, -VV1, and -VV2)

Cancers (Basel):显著性前列腺癌的MRI自动化分类

基于MRI的使用放射组学或者深度学习的方法来对显著前列腺癌(sPCa)进行分类得到了广泛的关注,因其在协助临床决策过程中有着潜在的应用。