严德星?文正青

[摘要] 目的 探討MRI评价再发缓解型多发性硬化患者脑干横截面积及其临床意义。 方法 临床选择2015年6月～2017年3月本院收治的再发缓解型多发性硬化患者15例为疾病组，另选取同期健康体检者15例为对照组，应用MRI检查两组的中脑面积、桥脑面积和延髓面积，评估疾病组与对照组的中脑面积、桥脑面积和延髓面积；采用美国国立卫生研究院卒中量表评估患者神经功能情况，评估疾病组脑组织不同萎缩程度的神经功能情况。 结果 疾病组的中脑面积、桥脑面积、延髓面积分别为（56.6±7.3）、（34.8±4.8）、（15.8±3.7）mm2显著低于对照组的（78.5±8.9）、（50.4±10.9）、（36.9±4.8）mm2，差异有统计学意义（P<0.05）；疾病组的再发缓解型多发性硬化脑萎缩分级1 ～ 2级者的NIHSS评分（16.6±3.3）分显著低于3 ～ 4级的（28.5±8.9）分，差异有统计学意义（P<0.05）。 结论 MRI可用于评估再发缓解型多发性硬化患者的脑萎缩程度，进而提高对再发缓解型多发性硬化患者病情危险程度评估的准确性及实施针对性治疗措施的预见性。

[关键词] 脑干横截面积；再发缓解型多发性硬化；MRI

[中图分类号] R259 [文献标识码] A [文章编号] 2095-0616（2017）09-167-03

Evaluation of cross sectional area of brain stem of relapsing remitting multiple sclerosis patients by MRI and its clinical significance

YAN Dexing WEN Zhengqing

Department of Medical Imaging， Shaoguan First People's Hospital， Shaoguan 512000， China

[Abstract] Objective To explore the evaluation of cross sectional area of brain stem of relapsing remitting multiple sclerosis patients by MRI and its clinical significance. Methods 15 cases of relapsing remitting multiple sclerosis patients cured in our hospital from June 2015 to March 2016 were selected as the disease group， and 15 cases of healthy physical examination during the same period were selected as control group. Midbrain area， pontine area and medulla area of the two groups were examined by MRI. Midbrain area， pontine area and medulla area of disease group and control group were evaluated. Neurological function was evaluated by stroke scale of National Institutes of health. Neurological function of brain tissue with different degrees of atrophy of disease group was evaluated. Results Midbrain area， pontine area， medulla area of disease group were （56.6±7.3）， （34.8±4.8）， （15.8±3.7）mm2， which were significantly less than those of control group with （78.5±8.9）， （50.4±10.9）， （36.9±4.8）mm2， and the differences were statistically significant （P<0.05）. NIHSS scores of patients with relapsing remitting multiple sclerosis cerebral atrophy grade 1-2 was （16.6±3.3）， which was significantly that of grade 3-4 with （28.5±8.9）， and the difference was statistically significant （P<0.05）. Conclusion MRI can be used to evaluate the degree of brain atrophy in patients with relapsing remitting multiple sclerosis， and then to improve the accuracy of the risk assessment of patients with relapsing remitting multiple sclerosis and the predictability of the implementation of targeted therapies.

[Key words] Cross sectional area of brain stem； Relapsing remitting multiple sclerosis； MRI

多发性硬化是中枢神经系统进行性脱髓鞘疾病，可分为再发缓解型、继发进展型、原发进展型和进展复发型，其中再发缓解型是最常见的类型，85%的多发性硬化为再发缓解型[1]。多发性硬化患者可

表现为四肢无力、异样感觉、共济失调等多种症状，可明显影响患者的健康和生存质量。因此其病情评估和有效干预十分重要[2]。长期以来，多发性硬化患者神经功能损伤缺乏影像学评价指标，而脑干是多发性硬化常累及的部位，脑干的变化可能与多发性硬化患者神经功能损伤等病情变化相关。本研究通过MRI检查评价再发缓解型多发性硬化患者（疾病组）的中脑、脑桥、延髓等脑干横截面积的变化，与同年龄同性别的健康志愿者（对照组）进行对比，并进行脑卒中量表神经功能缺损NIHSS评估其神经功能损伤程度，效果满意，现报道如下。……