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Objective To explore the role of magnetic resonance spectroscopy in evaluating the severity and prognosis of patients with brain stem injury. Methods A total of 45 patients with brain injury (the study group)and 10 healthy people(the control group)were retrospectively analyzed in Affiliated Anqing Hospital,Anhui Medical University during March 2015 to October 2016 using magnetic resonance spectroscopy.The NAA/Cr,NAA/Cho and Cho/Cr value in brain stem were analyzed. The clinical severity score (GCS) and Glasgow outcome scale (GOS)were also analyzed in our study. Results Compared with the normal group,patients in the study group had lower NAA level, NAA/Cho value but higher Cho/Cr value (P < 0.05). The severer the injury, the more obvious in NAA peak decrease. Cho peak increased and NAA/Cho ratio decreased. NAA/Cho, NAA/Cr and Cho/Cr values in the group with good prognosis were similar to those in the normal control group, but significantly different to the group with poor prognosis (P < 0.05). NAA/Cr, NAA/Cho and Cho/Cr values correlates with GOS in patients with brain stem injury. Conclusions Magnetic resonance spectroscopy can be used to measure the metabolic status of patients with brain stem injury,which is of great significance in the evaluation the severity of brain stem injury and prognosis.
RESUMO
Objective To observe the expression of aquaporin 4 (AQP-4) in contused brain tissue and its relationship with brain edema following brain trauma.Methods A retrospective case control analysis was made on 42 patients with severe brain trauma admitted from January 2015 to March 2016.There were 23 males and 19 females,aged from 23 to 62 years [(35.5 ± 5.6) years].Glasgow coma score (GCS) was 3-5 points in 7 patients,6-8 points in 23 and 9-10 points in 12.Brain tissue removed from the area 1 cm near the contusion during the cranial surgery were allocated to study group (n =42),while brain tissue removed far from the contusion after internal decompression were used as control (n =8).Ultrastructure of brain tissues was observed under electron microscope.Water content of brain tissue was measured by dry-wet weight method and expression of AQP-4 was measured by immunohistochemical method at postinjury hours ＜ 6,6-12,12-24,24-72,72-96 and ＞ 96.Results Morphology and structure of brain tissue in control group were normal.Whereas in study group,the intracellular and interstitial edema were obvious and morphological structure were damaged.Water content and AQP-4 expression in control group showed no obvious increase after operation(73.55 ±0.10,0.193 ±0.016).Water content in study group increased significantly compared to control group and reached the peak value (81.28 ± 0.56) at postinjury 24-72 hours (P ＜ 0.01).AQP-4 expression in study group increased at postinjury 6 hours (0.242 ±0.023) and reached a peak at postinjury 24-72 hours (0.338 ± 0.013),with significant difference compared to control group (P ＜ 0.05).Correlation analysis showed change of brain water content was positively correlated with expression level of AQP-4 (r =0.931,P ＜ 0.01).Conclusion Expression of AQP-4 in the injured area of brain trauma is significantly increased along with the increase of water content,suggests that the upregulation of AQP-4 plays an important role in traumatic brain edema.