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目的:糖尿病酮症酸中毒(DKA)患儿,在治疗过程中会因其脑细胞渗透性水肿而导致脑水肿。本文以治疗期DKA患儿作为研究对象,测定其脑脊液的分布和灌注情况。研究方法:根据加权MRI对脑组织进行弥散成像和灌注成像,检测14例治疗期DKA患儿,确定显著性弥散系数(ADC),同时检测相应的脑灌注量。结果:在患儿治疗期间(一般处于弥散期),除枕部灰质外,其他部位ADC均见显著性增高。从前期治疗到后期恢复, MRI图像反映的各部位弥散系数平均减少量如下:基底部(4.7±2.5)×10-5 mm2/s(P=0.002),丘脑(3.7±2.8)×10-5 mm2/s(P=0.002),导水管部灰质(4.3±5.1)×10-5 mm2/s(P=0.03),额部的白质(2.0±3.1) ×10-5 mm2/s(P=0.03)。对比整个治疗过程的MRI 图像,以枕部灰质的ADC增加最为显著[平均增加(3.9±3.9)×10-5 mm2/s(P=0.004)]。所以,在DKA 治疗期间,可利用MRI检测脑灌注值,呈现显著变化性的两个指标为:平均透过时间(MMTs)和浓度曲线峰值,前者过短,后者偏高,二者可提示大脑血流量(CBF)增多。结论:在DKA患儿治疗期间,ADC值上升,证明脑水肿形成是一个血管源性的过程,而非渗透性的细胞水肿。
OBJECTIVE: Children with diabetic ketoacidosis (DKA) develop brain edema as a result of their penetrating edema of brain cells during treatment. In this paper, the treatment of DKA in children as the object of study to determine the distribution and perfusion of cerebrospinal fluid. Methods: According to weighted MRI, diffusion imaging and perfusion imaging of brain tissue were performed in 14 children with DKA during the treatment period to determine significant diffusion coefficient (ADC) and corresponding brain perfusion. Results: During the treatment of children (usually in the diffuse phase), in addition to occipital gray matter, other parts of ADC were significantly increased. From the early treatment to the late recovery, the average reduction of diffusivity of each part reflected by the MRI image was as follows: basal (4.7 ± 2.5) × 10-5 mm2 / s (P = 0.002), thalamus (3.7 ± 2.8) × 10-5 mm2 / s (P = 0.002), the amount of gray matter in the aqueduct (4.3 ± 5.1) × 10-5 mm2 / s (P = 0.03) and the amount of white matter (2.0 ± 3.1) × 10-5 mm2 / 0.03). Comparing MRI images of the whole course of treatment with occipital gray matter showed the most significant increase in ADC (mean increase (3.9 ± 3.9) × 10-5 mm2 / s (P = 0.004)]. Therefore, during DKA treatment, cerebral perfusion values can be measured using MRI with two indicators of significant variability: mean transit time (MMTs) and peak concentration curves, the former being too short and the latter being high, both of which suggest Increased cerebral blood flow (CBF). CONCLUSIONS: ADC values increased during treatment of children with DKA, demonstrating that brain edema formation is a vasculogenic process and that non-osmotic cell edema is present.