Correlation between Patent Foramen Ovale, Cerebral "Lesions" and Neuropsychometric Testing in Experienced Sports Divers: Does Diving Damage the Brain?
Correlation between Patent Foramen Ovale, Cerebral "Lesions" and Neuropsychometric Testing in Experienced Sports Divers: Does Diving Damage the Brain?
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DOI：
10.3389/fpsyg.2016.00696
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发表时间：
2016
影响因子：
3.8
通讯作者：
Germonpré P
中科院分区：
文献类型：
--
作者：
Balestra C;Germonpré P
戴水肺潜水会使潜水员患上减压病。心脏卵圆孔未闭的潜水员是否会因为静脉减压气泡可能从右向左分流进入动脉循环而有更高的分布式心血管疾病风险，这一点一直存在相当大的争论。有症状的神经性DCs已被证明会对脑和脊髓组织造成永久性损害；已有研究表明，患有PFO的潜水员可能会因为反复无症状地栓塞减压诱导的氮气泡而发生亚临床脑损伤的风险更高。然而，这些研究存在几个方法上的缺陷，包括自我选择的偏见。我们从一个休闲潜水人群中招募了200名志愿潜水员，这些潜水员从未患过分散性潜水症；然后我们随机选择了其中的50人进行进一步调查。选定的潜水员接受了脑磁共振成像以检测无症状的脑损伤，经食道超声心动图检查PFO，以及广泛的神经心理测试。神经心理测量结果与正常受试者的对照组和暴露于神经毒性溶剂的受试者的单独对照组进行了比较。42名潜水员接受了所有测试，并被包括在本报告中。16名潜水员(38%)发现卵圆孔未闭，5名(11.9%)发现脑内不明亮物(UBO)。在潜水员中，PfO与UBO的存在(P=0.693)或其大小(P=0.50)无关。潜水员的神经心理测试在数字跨度(DSB；p<；0.05)和符号-数字替换(sds；p<；0.01)两个测试中明显比对照组差。与暴露在神经毒性溶剂中的受试者相比，潜水员在DSB和SDS测试中得分相似，但在简单反应时间(REA)和手眼协调(眼睛)测试中明显更好。在PFO、UBO次数和任何神经心理测试之间没有相关性。我们的结论是，对于平淡无奇的休闲潜水，PFO似乎不会影响UBO的存在。潜水本身似乎会导致短期记忆和更高的认知功能，包括视觉运动技能的一些下降；这类似于氮气麻醉的一些影响，我们认为这可能是潜水的长期影响。
SCUBA diving exposes divers to decompression sickness (DCS). There has been considerable debate whether divers with a Patent Foramen Ovale of the heart have a higher risk of DCS because of the possible right-to-left shunt of venous decompression bubbles into the arterial circulation. Symptomatic neurological DCS has been shown to cause permanent damage to brain and spinal cord tissue; it has been suggested that divers with PFO may be at higher risk of developing subclinical brain lesions because of repeated asymptomatic embolization of decompression-induced nitrogen bubbles. These studies however suffer from several methodological flaws, including self-selection bias. We recruited 200 volunteer divers from a recreational diving population who had never suffered from DCS; we then randomly selected 50 of those for further investigation. The selected divers underwent brain Magnetic Resonance Imaging to detect asymptomatic brain lesions, contrast trans-oesophageal echocardiography for PFO, and extensive neuro-psychometric testing. Neuro-psychometry results were compared with a control group of normal subjects and a separate control group for subjects exposed to neurotoxic solvents. Forty two divers underwent all the tests and are included in this report. Grade 2 Patent Foramen Ovale was found in 16 (38%) of the divers; brain Unidentified Bright Objects (UBO's) were found in 5 (11.9%). There was no association between PFO and the presence of UBO's (P = 0.693) or their size (p = 0.5) in divers. Neuropsychometric testing in divers was significantly worse from controls in two tests, Digit Span Backwards (DSB; p < 0.05) and Symbol-Digit-Substitution (SDS; p < 0.01). Compared to subjects exposed to neurotoxic solvents, divers scored similar on DSB and SDS tests, but significantly better on the Simple Reaction Time (REA) and Hand-Eye Coordination (EYE) tests. There was no correlation between PFO, number of UBO's and any of the neuro-psychometric tests. We conclude that for uneventful recreational diving, PFO does not appear to influence the presence of UBO's. Diving by itself seems to cause some decrease of short-term memory and higher cognitive function, including visual-motor skills; this resembles some of the effects of nitrogen narcosis and we suggest that this may be a prolonged effect of diving.