磁共振成像的结构性病变与意识障碍患者预后的关系研究

Association between Structural Lesions on Magnetic Resonance Imaging and Prognosis in Patients with Disorders of Consciousness

摘要: 目的：通过评估磁共振成像(MRI)的结构性病变情况来预测意识障碍(DOC)患者的功能结局。方法：回顾性收集81例DOC患者的临床数据，定性评估MRI中的脑实质病变分布及范围，结局指标定义为发病6个月后意识水平的分类。首先采用有序逻辑回归分析评估各临床及影像学因素与预后之间的关系，然后使用二元逻辑回归分析筛选出意识无明显恢复的独立预测因子。结果：有序逻辑回归分析结果显示，瞳孔对光反射消失(P = 0.007)、MRI显示的左基底节区(P = 0.026)、右基底节区(P = 0.036)和右侧脑干(P = 0.008)大范围或弥漫性病变与DOC患者预后显著相关。二元逻辑回归结果表明，左基底节区病变(P = 0.004)、右基底节区病变(P = 0.037)、右侧脑干病变(P = 0.006)、瞳孔对光反射消失(P = 0.036)是意识无明显恢复的独立预测因子。结论：瞳孔对光反射消失、基底节区和脑干大范围或弥漫性病变与DOC患者不良预后紧密相关。

Abstract: Objective: To predict functional outcomes in patients with Disorders of Consciousness (DOC) by evaluating structural lesions on Magnetic Resonance Imaging (MRI). Methods: Clinical data from 81 patients with DOC were retrospectively collected. The distribution and extent of cerebral parenchymal lesions on MRI were qualitatively assessed. The outcome measure was defined as the classification of the level of consciousness at 6 months after disease onset. Ordinal logistic regression analysis was first performed to evaluate the associations between clinical and imaging variables and prognosis. Subsequently, binary logistic regression analysis was used to identify independent predictors of poor consciousness recovery. Results: Ordinal logistic regression analysis revealed that absence of pupillary light reflex (P = 0.007), extensive or diffuse lesions in the left basal ganglia (P = 0.026), right basal ganglia (P = 0.036), and right brainstem (P = 0.008) on MRI were significantly associated with prognosis in DOC patients. Binary logistic regression analysis further demonstrated that lesions in the left basal ganglia (P = 0.004), right basal ganglia (P = 0.037), right brainstem (P = 0.006), and absence of pupillary light reflex (P = 0.036) were independent predictors of poor recovery of consciousness. Conclusion: Absence of pupillary light reflex and extensive or diffuse lesions involving the basal ganglia and brainstem are strongly associated with unfavorable outcomes in patients with disorders of consciousness.