特种作战部队成员的卵圆孔扩大与终生接触大型爆炸物有关。

摘要(中文译文)

透明隔腔（CSP）是一种常见的神经影像学发现，与重复性头部创伤有关，但它与军事人群中爆炸暴露的关系仍然难以捉摸。在这里，我们研究了特种作战部队（SOF）人员一生中暴露于不同类型爆炸的情况是否与CSP形态有关。我们回顾性分析了来自总部综合脑健康和创伤计划的323名特种作战部队成员，他们完成了高分辨率3T MRI和爆炸暴露阈值调查（BETS），该调查量化了五个爆炸暴露计数类别（BEC1-BEC5）中爆炸性武器的终生暴露。使用冠状3D T1加权磁化制备快速梯度回波扫描的验证标准评估CSP等级和长度。计算CSP长度与隔膜长度之比（CSP比率），以调整解剖变异。BEC1-BEC5被对数转换为正确的偏度，被称为log-BEC1-5。方差膨胀因子分析表明，预测因子（log-BEC1-5和年龄）之间的多重共线性较低，使用最小绝对收缩和选择算子回归进行变量选择，确定log-BEC5（暴露于大型爆炸物）是唯一保留的预测因子。在完全调整后的模型中，只有log-BEC5与CSP指标保持显著相关性，因此是后续分析的重点。参与者按BEC5=0与BEC5>0进行分层，并使用组间比较、多变量回归和剂量反应模型评估与CSP测量的相关性。在323名参与者（平均年龄42.7±8.8岁）中，273名（84%）报告了任何BEC5暴露。BEC5>0的SOF成员的CSP存在率明显更高（42.1%对22.0%，=0.007），CSP长度更长（中位数为3mm对2mm，=0.002）。在年龄校正模型中，BEC5>0与CSP存在的可能性更大（OR=2.58，95%CI 1.26-5.25，=0.009）和CSP长度增加1.45 mm（=0.004）有关。在连续模型中，log-BEC5每增加一个单位，CSP长度就会增加0.31毫米（=0.008），CSP比率会增加0.0059毫米（=0.0.008）。这些发现表明，累积暴露于重炸药与CSP扩大之间存在统计学上的显著关联，表明CSP可能是爆炸相关神经创伤的潜在影像学标志。

Abstract

Cavum septum pellucidum (CSP) is a common neuroimaging finding linked to repetitive head trauma, yet its relationship to blast exposure among the military population remains elusive. Here, we investigated whether lifetime exposure to different types of blast is associated with CSP morphology among Special Operations Forces (SOF) personnel. We retrospectively analyzed 323 SOF members from the Comprehensive Brain Health and Trauma Program at Home Base who completed high-resolution 3T MRI and the Blast Exposure Threshold Survey (BETS), which quantifies lifetime exposure to explosive weapons across five blast exposure count categories (BEC1-BEC5). CSP grade and length were assessed using validated criteria on coronal 3D T1-weighted Magnetization Prepared Rapid Gradient Echo scans. A CSP length-to-septum length ratio (CSP ratio) was calculated to adjust for anatomical variation. BEC1-BEC5 were log-transformed to correct skewness and are referred to as log-BEC1-5.Variance inflation factor analysis indicated low multicollinearity among predictors (log-BEC1-5 and age), and variable selection using Least Absolute Shrinkage and Selection Operator regression identified log-BEC5 (exposure to large explosives) as the only retained predictor. In fully adjusted models, only log-BEC5 remained significantly associated with CSP measures and was therefore the focus of subsequent analyses.Participants were stratified by BEC5 = 0 vs. BEC5 > 0, and associations with CSP measures were assessed using group comparisons, multivariable regression, and dose-response models.Among 323 participants (mean age 42.7 ± 8.8 years), 273 (84%) reported any BEC5 exposure. SOF members with BEC5 > 0 had significantly greater CSP presence (42.1% vs. 22.0%, = 0.007) and longer CSP length (median 3 mm vs. 2 mm, = 0.002). In age-adjusted models, BEC5 > 0 was associated with greater odds of CSP presence (OR = 2.58, 95% CI 1.26-5.25, = 0.009) and a 1.45 mm increase in CSP length ( = 0.004). In continuous models, each one-unit increase in log-BEC5 was associated with a 0.31 mm increase in CSP length ( = 0.008) and a 0.0059 increase in CSP ratio ( = 0.008).These findings indicate a statistically significant association between cumulative exposure to heavy explosives and CSP enlargement, suggesting that CSP may serve as a potential imaging marker of blast-related neurotrauma.

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