Dissociation of cerebral glucose metabolism and level of consciousness during the period of metabolic depression following human traumatic brain injury
Dissociation of cerebral glucose metabolism and level of consciousness during the period of metabolic depression following human traumatic brain injury
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DOI：
10.1089/neu.2000.17.389
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发表时间：
2000-05-01
影响因子：
4.2
通讯作者：
Becker, DP
中科院分区：
文献类型：
--
作者：
Bergsneider, M;Hovda, DA;Becker, DP
利用[F-18]氟脱氧葡萄糖正电子发射断层扫描（FDG-PET），我们研究了CMRglc和意识水平在人创伤性脑损伤后第一个月内的相关性。本文对42例轻、重型颅脑损伤患者的43次FDG-PET扫描进行了脑局部葡萄糖代谢率（CMRglc）的定量分析。脑葡萄糖利用率降低，定义为CMRglc小于或等于4.9 mg/100 g/min，在88%的研究中存在区域性。严重头部损伤患者的总体皮质CMRglc降低的发生率较高（86% vs 67%轻度-中度），尽管在损伤严重程度谱中的绝对幅度相似（平均CMRglc 3.9 +/- 0.6 mg/100 g/min）。通过格拉斯哥昏迷量表测量的意识水平与整体皮质CMRglc值相关性较差（r = 0.08; p = 0.63）。关于头部损伤的严重程度，这种相关性在严重损伤患者中最差（r = -0.11; p = 0.58），在轻度损伤患者中更好（r = 0.50; p = 0.07）。在大多数情况下，脑实质内出血性病变与局灶性CMRglc降低或升高相关。可以得出结论，CMRglc减少的病因可能是多因素的复杂性质的创伤性脑损伤和CMRglc的减少代表了一个基本的病理生物学状态，头部损伤，不紧密耦合到意识水平。
Utilizing [F-18]fluorodeoxyglucose positron emission tomography (FDG-PET), we studied the correlation between CMRglc and the level of consciousness within the first month following human traumatic brain injury. Forty-three FDG-PET scans obtained on 42 mild to severely head-injured patients were quantitatively analyzed for the determination of regional cerebral metabolic rate of glucose (CMRglc). Reduction of cerebral glucose utilization, defined as a CMRglc of less than or equal to 4.9 mg/100 g/min, was present regionally in 88% of the studies. The prevalence of global cortical CMRglc reduction was higher in severely head-injured patients (86% versus 67% mild-moderate), although the absolute magnitude was similar across the injury severity spectrum (mean CMRglc 3.9 +/- 0.6 mg/100 g/min). The level of consciousness, as measured by the Glasgow Coma Scale, correlated poorly with the global cortical CMRglc value (r = 0.08; p = 0.63). With regards to severity of head injury, this correlation was worst for the severely injured (r = -0.11; p = 0.58) and better for the mildly injured patients (r = 0.50; p = 0.07). In most cases, intraparenchymal hemorrhagic lesions were associated with either focal CMRglc reduction or elevation. It is concluded that the etiologies of CMRglc reduction are likely multifactorial given the complex nature of traumatic brain injury and that the reduction of CMRglc represents a fundamental pathobiologic state following head injury that is not tightly coupled to level of consciousness.