Impact of methamphetamine on regional metabolism and cerebral blood flow after traumatic brain injury.
Impact of methamphetamine on regional metabolism and cerebral blood flow after traumatic brain injury.
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DOI：
10.1007/s12028-013-9871-9
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发表时间：
2013-10
影响因子：
3.5
通讯作者：
Chang, Linda
中科院分区：
文献类型：
--
作者：
O'Phelan, Kristine;Ernst, Thomas;Park, Dalnam;Stenger, Andrew;Denny, Katherine;Green, Deborah;Chang, Cherylee;Chang, Linda
药物滥用是创伤性脑损伤 (TBI) 患者常见的合并症，但人们对其对组织损伤或 TBI 恢复的潜在累加或相互作用影响知之甚少。本研究旨在评估在维持 TBI 之前使用甲基苯丙胺 (METH) 的受试者的区域代谢和脑灌注变化。我们假设，与不使用冰毒的患者相比，使用冰毒会降低 TBI 患者的挫伤周围脑灌注和神经元代谢标志物。这是一项单中心前瞻性观察研究。患有中度和重度 TBI 的成年人也被纳入其中。 MRI 扫描是在 3 特斯拉扫描仪上进行的。 MP-RAGE 和 FLAIR 序列以及 MP-RAGE 扫描中识别的挫伤周围和对侧体素中 NAA 和乳酸的代谢物谱。基于螺旋的 FAIR 序列用于采集脑血流 (CBF) 图。使用 Image J 开源软件分析区域 CBF 图像。对整个队列以及 METH 组和非 METH 组的挫伤周围和对侧 CBF、NAA 和乳酸进行了评估。 17 名受试者完成了 MR 研究。整个队列的分析：与对侧 NAA (6.98 ± 1.2 mM/kg；p=0.03) 相比，挫伤周围 NAA 浓度 (5.81 ± 2.0 mM/kg) 低 12%。两个区域之间的乳酸浓度和CBF没有显着差异，但是两个区域的局部脑血流量同样减少。亚组分析：41% 的受试者冰毒检测呈阳性。各组之间的平均年龄、格拉斯哥昏迷量表和扫描时间没有差异。两个受试者组也有相似的区域 NAA 和乳酸。 METH 使用者的挫伤周围 CBF 比非使用者低 60%，p=0.04；各组之间对侧 CBF 没有差异。这项小型研究表明，TBI 后组织代谢存在区域异质性，并且 METH 亚组的挫伤周围灌注显着减少。
Substance abuse is a frequent comorbid condition among patients with Traumatic Brain Injury (TBI), but little is known about its potential additive or interactive effects on tissue injury or recovery from TBI. This study aims to evaluate changes in regional metabolism and cerebral perfusion in subjects who used methamphetamine(METH) prior to sustaining a TBI. We hypothesized that METH use would decrease pericontusional cerebral perfusion and markers of neuronal metabolism, in TBI patients compared to those without METH use. This is a single center prospective observational study. Adults with moderate and severe TBI were included. MRI scanning was performed on a 3 Tesla scanner. MP-RAGE and FLAIR sequences as well as Metabolite spectra of NAA and lactate in pericontusional and contralateral voxels identified on the MP-RAGE scans. A spiral-based FAIR sequence was used for the acquisition of cerebral blood flow (CBF) maps. Regional CBF images were analyzed using Image J open source software. Pericontusional and contralateral CBF, NAA and lactate were assessed in the entire cohort and in the METH and non-METH groups. 17 subjects completed the MR studies. Analysis of entire cohort: Pericontusional NAA concentrations (5.81 ± 2.0 mM/kg) were 12% lower compared to the contralateral NAA (6.98 ± 1.2 mM/kg; p=0.03). Lactate concentrations and CBF were not significantly different between the two regions, however, regional cerebral blood flow was equally reduced in the two regions. Subgroup analysis: 41% of subjects tested positive for METH. The mean age, Glasgow Coma Scale and time to scan did not differ between groups. The two subject groups also had similar regional NAA and lactate. Pericontusional CBF was 60% lower in the METH users than the non-users, p=0.04; contralateral CBF did not differ between the groups. This small study demonstrates that tissue metabolism is regionally heterogeneous after TBI and pericontusional perfusion was significantly reduced in the METH subgroup.
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