| Objective:To explore the effect of hyperbaric oxygen therapy（HBOT）for cognitive impairment after traumatic brain injury（TBI）by using proton magnetic resonance spectroscopy（1H-MRS）,so as to provide clinical basis for the curative effect of HBOT.Methods:According to the Glasgow Coma Score（GCS）,56 patients with cognitive impairment after TBI were randomly divided into hyperbaric oxygen treatment group（HBOT group）and non-hyperbaric oxygen treatment group（NHBOT group）,with 28 patients in each group.HBOT group was treated with HBO,cognitive rehabilitation training and basic therapy,while NHBOT group was just treated with cognitive rehabilitation training and basic therapy for 30days.Patients in both groups were completed Mini-mental State Examination（MMSE）,Montreal Cognitive Assessment scale（Mo CA）,Activity of Daily Living（ADL）and 1H-MRS scan before and after treatment,the scores of each scale were recorded and the hippocampus was selected as the area of interest.The ratio of total N-acetylaspartate to total creatine（t NAA/Cr）,the ratio of total choline to total creatine（t Cho/Cr）,and the ratio of total N-acetylaspartate to total choline+total creatine（t NAA/Cho+Cr）were recorded in the ipsilateral and contralateral hippocampus.The ratio of the scale score to the metabolites of the hippocampus was taken as the main outcome index.Ten patients were randomly selected from the two groups,and the hippocampal metabolite ratio was recorded before treatment,and 10healthy volunteers matched with age,sex and education were recruited to observe the difference of hippocampal metabolite ratio between patients with cognitive impairment after TBI and healthy volunteers.Using SPSS22.0 statistical software,the scale score and metabolite ratio of the two groups before and after treatment were statistically analyzed,and the effects of age and sex on the ratio of metabolites in the hippocampus were removed,and the partial correlation analysis was used to compare the correlation between the difference of scale score and the difference of metabolic ratio between the two groups before and after treatment,and to explore the effect of HBOT on patients with cognitive impairment after TBI according to the results of the study.Results:1.In terms of scale scores,it was found that the scores of MMSE and ADL in the two groups were significantly higher than those before treatment（P<0.001）.From the analysis,the scores of MMSE and ADL in the HBOT group were significantly higher than those in the NHBOT group（P<0.001）.Compared with those before treatment,the total score of Mo CA and the scores of each cognitive domain in the two groups were significantly higher than those in the NHBOT group.The scores of attention,calculation,delayed recall,orientation and total score of Mo CA in the HBOT group were significantly higher than those in the NHBOT group（P<0.05）.2.In terms of metabolite ratio,it was found that compared with healthy volunteers,the ratio of NAA/Cr in hippocampus of patients with cognitive impairment after TBI decreased significantly（P<0.05）,while the ratio of Cho/Cr increased,and the ratio of NAA/Cho+Cr decreased significantly（P<0.01）.Compared with those before treatment,the ratio of NAA/Cr and NAA/Cho+Cr in the ipsilateral hippocampus of the two groups increased（P<0.001）.and the Cho/Cr of NHBOT group decreased after treatment,but there was no significant difference（P>0.05）.After treatment,the ratio of Cho/Cr in HBOT group decreased（P<0.05）,and the difference was statistically significant.The increase degree of NAA/Cr and NAA/Cho+Cr ratios in HBOT group was better than that in NHBOT group,and the decrease of Cho/Cr ratio was more obvious than that in NHBOT group,and the difference was statistically significant（P<0.05）.3.In terms of correlation,the effects of gender and age on the changes of metabolites were removed,and the partial correlation between the difference of scale score before and after treatment and the difference of hippocampal metabolite ratio between the two groups was analyzed and compared.In this study,it was found that in the HBOT group,there was a positive correlation between d Mo CA and d NAA/Cr before and after treatment,and a negative correlation between d Mo CA and d Cho/Cr before and after treatment.There was a positive correlation between d NAA/Cho+Cr and delayed recall（r=0.479,P<0.05）,the attention and d NAA/Cho+Cr（r=0.463,P<0.05）,d ADLand d NAA/Cho+Cr（r=0.468,P<0.05）,but there was no correlation between d MMSE and the difference of metabolites ratio（P>0.05）.And there was no correlation between d MMSE,d Mo CA,d ADL and the ratio of metabolites in NHBOT group before and after treatment.Conclusion:1.Traditional cognitive rehabilitation training can improve cognitive impairment after TBI.Compared with the former,hyperbaric oxygen therapy combined with cognitive rehabilitation training can significantly improve the cognitive function score and activities of daily living of patients with cognitive impairment after TBI.2.Hippocampal substance metabolism changes in patients with cognitive impairment after TBI.The improvement of cognitive function after hyperbaric oxygen treatment of TBI may be related to the increase of NAA/Cr,the decrease of Cho/Cr and the increase of NAA/Cho+Cr in the ipsilateral hippocampus.Therefore,the changes of NAA/Cr,Cho/Cr and NAA/Cho+Cr can be used as biomarkers of cognitive function recovery after TBI.It provides evidence of substance metabolism level for verifying the efficacy of hyperbaric oxygen. |
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