阿尔茨海默病患者脑体积变化二年随访对照研究

Brain volume changes of patients with Alzheimer＇s disease in two years： a case control study

目的研究阿尔茨海默病（AD）患者脑体积变化的特征。方法研究对象为轻中度阿尔茨海默病患者（AD组）和志愿入组的正常对照老人（NC组）。基线共入组23例AD以及年龄、性别及受教育年限与之相匹配的正常对照老人。2年后完成随访的有10例AD和11名正常对照老人。在基线和随访时应用3D-MRI技术测量海马、杏仁体、内嗅皮质、旁嗅皮质、颞角、胼胝体、钩间距等指标。在GE后处理工作站上对3D-MRI资料进行后处理和标准化并进行计算机统计。结果基线AD组与NC组比较后显示在以下标准化指标上差异有统计学意义：钩间距长度（11±4vs7±3。P〈0．01），侧脑室颞角总体积（1．21±1．00vs0．59±0．54，P〈0．05），内嗅皮质总体积（2．52±0．86vs3．67±0．54，P〈0．01），旁嗅皮质总体积（2．19±0．62vs3．39±0．51，P〈0．01）和海马总体积（3．23±0．75vs3．98±0．38，P〈0．01）。随访AD组与NC组比较后显示在以下标准化指标上差异仍有统计学意义：钩间距长度（11±4vs7±4，P〈0．05），侧脑室颞角总体积（6．75±4．60vs0．60±0．58．P〈0．01），内嗅皮质总体积（1．79±0．56vs2．76±0．50，P〈0．01），旁嗅皮质总体积（1．77±0．59vs2．76±0．41，P〈0．01）和海马总体积（2．80±0．80vs3．59±0．38，P〈0．05）。在两组之间只有海马体积年变化率差异有统计学意义，正常对照组年变化率为7％±4％，而AD组达11％±6％。结论阿尔茨海默病患者的颞叶结构萎缩与正常对照比较，差异有统计学意义。海马体积的年变化率在AD的诊断和进展评估中有一定参考价值。

Objective To study the brain volume changes of patients with Alzheimer＇s disease （AD）. Methods 23 patients with （AD and 23 sex, age, and educational background-matched normal controls （ NC group） underwent three-dimensional MRI to measure the hippocampus, amygdala, entorhinal cortex （EC）, perirhinal cortex （PC）, cornu temporale, and uncus distance in the baseline survey. Two years later 10 AD patients and 11 normal controls underwent 3-D MRI once again in the follow-up survey. Results The baseline survey showed that the levels of uncus distance and total temporal horn volume of the ADS patients were 11 ±4 and 1.21 ± 1.00 respectively, both significantly higher than those of the NC group （7 ± 3 and 0.59 ± 0. 54 respectively, P 〈 0. 01, P 〈 0. 05 ）, and the levels of total entorhinal cortex volume, total perirhinal cortex volume, and total hippocampus volume were 2.52 ±0. 86, 2. 19 ±0. 62, and 3.23 ± 0.75 respectively, all significantly lower than those of the BC group （ 3.67 ± 0.54, 3.39 ± 0. 51, and 3.98 ±0. 38, all P 〈0.01 ）. The levels of uncus distance and total temporal horn volume of the AD patients during the follow-up survey were 11 ± 4 and 1.21 ± 1. 130 respectively, both significantly higher than those of the NC group （7 ± 3 and 0. 59 ± 0. 54 respectively, both P 〈 0. 05 ） ; and the total entorhinal cortex volume, total perirhinal cortex volume, and total hippocampus volume of the AD patients during the follow- up survey were. 1.79 ± 0.56, 1.77 ± 0. 59, and 2. 80 ± 0. 80 respectively, all significantly lower than thoseof the NC group （2,76±0.50, 2.76±0.41, and3.59 ±0.38 respectively, all P〈0.01）. Conclusion The AD patients have more remarkable atrophy of entorhinal cortex, perirhinal cortex, and have obvious extension of eornu temporale and uneus distance in comparison with the normal controls. The shrinkage rate of hippoeampus can be used as a marker for the diagnosis and progress of AD.