帕金森病痴呆氢质子核磁共振波谱的研究

Study of ^1H magnetic resonance spectroscopy in Parkinson disease with dementia

目的利用氢质子磁共振波谱(1H MRS)技术,研究认知障碍的帕金森病(PD)患者脑部代谢变化。进一步探索帕金森痴呆(PDD)患者发生痴呆的病因。方法早期PD患者(H&Y分级<Ⅲ级)38例(MMSE评分≥26分)、PDD患者(H&Y分级<Ⅲ级)33例和健康对照组(HC)25例行1H MRS检查,测定脑部壳核与额叶的N-乙酰天门冬氨酸/肌酸(NAA/Cr)和乙酰天门冬氨酸/胆碱复合物(NAA/Cho)比值。结果PDD组比HC组患肢同侧壳核NAA/Cr的比值明显降低,(1.365±0.127)vs(1.522±0.188)(P<0.01),PDD组与PD组比HC组患肢对侧壳核的NAA/Cr比值明显降低,(1.123±0.154)vs(1.393±0.195)vs(1.529±0.196)(均P<0.01),PDD组与PD组比HC组患肢对侧额叶的NAA/Cr的比值明显降低,(1.419±0.206)和(1.536±0.178)vs(1.633±0.198)(P<0.05)。3组的NAA/Cho比值差异无统计学意义(P>0.05)。结论1H MRS可以检测到PDD患者脑部的代谢改变,有助于PDD的病因诊断及风险预测。

Objective To evaluate N-acetylaspartate/creatine （NAA/Cr） and NAA/choline （Cho） using hydrogen proton magnetic resonance spectroscopy（^1H MRS） in Parkinson disease with dementia（PDD） for the cause of cognitive impairment with PDD. Methods Seventy-one patients （PD = 38, PDD= 33） and 25 age-matched healthy controls（HC） underwent serial volumetric 1.5T ^1H MRS. All patients （H＆Y〈Ⅲ ）were assessed using unified Parkinson disease rating scale（UPDRS） and mini-mental state examination（MMSE）,^1H MRS collection in the areas of the putamen and frontal lobe. Results There was a significant reduction in NAA/Cr ratio in contra-putamen to the worst clinically affected limbs of patients with PDD compared with PD, （1. 123± 0. 154） vs （1. 393±0, 195） （P〈 0.01）,and PD was lower compared to HC （ 1. 393± 0. 195） vs （ 1. 529 ± 0. 196） （ P 〈0.01）. There were significant reductions in NAA/Cr ratio in ipsil-putamen to the worst clinically affected limbs of the patients with PDD compared to HC, （1. 365 ± 0.127 ） vs （ 1. 522 ±0. 188） （ P 〈0.01）. Compared to HC, NAA/Cr ratio of contra-frontal lobe was significantly decreased in PD and PDD （1. 536±0. 178）, （1. 419±0. 206） vs （1. 633±0. 198） （ P 〈0.01）. There were no significant differences in other compared groups of NAA/Cr ratio. No abnormalities were observed in NAA/Cho （P 〉 0. 05）. Conclusion ^1H MRS may be a valuable tool for monitoring disease progression in PDD and further studies should investigate its utility for the early diagnosis.