急性一氧化碳中毒迟发脑病的磁共振波谱特征及其临床意义

Characteristics and significance of ^1H magnetic resonance spectroscopy in delayed encephalopathy following acute carbon monoxide poisoning

目的研究急性一氧化碳中毒迟发脑病（delayed encephalopathy following acute carbon monoxide poisoning, DEACOP）患者的质子磁共振波谱（ ^1H magnetic resonance spectroscopy, ^1H MRS）特征及临床意义。方法对38例DEACOP患者和30例正常志愿者分别进行常规核磁及质子磁共振波谱检查，对比分析DEACOP患者与正常志愿者的额叶、脑室旁、枕叶的N-乙酰天门冬氨酸（NAA）、肌酸／磷酸肌酸（cr）、含胆碱代谢物（Cho）含量的变化，对以cr为参照的代谢产物比值（Cho／Cr，Cho／NAA，NAA／Cr）进行比较，并分析NAA／Cr、Cho／Cr、Cho／NAA与患者简易智能状态检查量表（MMSE）和患者日常生活能力量表（ADL）的相关性。结果获取的DEACOP组患者波谱数据显示不同部位的NAA／Cr同对照组比较降低，差异有统计学意义（P〈0．叭），Cho／Cr、Cho／NAA同对照组比较增高，差异有统计学意义（P〈0．01）；Cho／Cr与MMSE、ADL评分呈明显负相关，Cho／NAA与MMSE、ADL评分呈明显负相关，NAA／Cr与MMSE、ADL评分呈明显正相关。中、重度DEACOP患者NAA／Cr同轻度患者比较降低，差异有统计学意义（P〈0．05），Cho／Cr、Cho／NAA同对照组比较增高，差异有统计学意义（P〈0．05）。结论通过’HMRS检测DEACOP患者脑部病灶的代谢异常可显示神经元损伤程度，代谢物比值异常变化提示预后不佳。

Objective To study the characteristics of proton magnetic resonance spectroscopy （^1H magnetic resonance spectroscopy, 1H MRS） in patients with delayed encephalopathy following acute carbon monoxide poisoning （DEACOP） and its significance in the early diagnosis of the disease. Methods MRI and ^1H MRS were performed in 38 DEACOP patients and 30 healthy volunteers. The ratios of N-acetylaspartate （NAA）, Creatine （Cr）, Choline （Cho） peaks were measured in each volume of interest, and the correlation of Activity of Daily Living Scale （ADL） and Mini-Mental State Examination （MMSE） with NAA/Cr, Cho/Cr, Cho/NAA were analyzed. Results Compared with those of the control group, the NAA/Cr ratio in different parts decreased with very significant statistical differences （ P 〈 0. 01 ） , while Cho/Cr and Cho/NAA ratio increased also with very significant statistical difference （ P 〈 0. 01 ）. Negative correlation was found in the assessment scores between Cho/Cr and MMSE, ADL. Cho/NAA was also negatively correlated in the assessment scores with MMSE and ADL, and NAA/Cr was positively correlated in the assessment scores with MMSE and ADL. The NAA/Cr ratio in moderate and serious DEACOP patients decreased, when it was compared with that of the mild DEACOP patients, with statistical differences （P 〈 0. 05）. Cho/Cr and Cho/NAA ratio increased, when it was compared with that of the control group, with statistical differences （P 〈 0. 05）. Conclusions ^1H MRS could detect metabolic abnormalities in DEACOP patients with brain lesion. Abnormal changes in the ratio of metabolites might indicate poor prognosis.