图雷特综合征患者双侧壳核的磁共振氢质子波谱特点

1^H-magnetic resonance spectrum of putaman of Tourette＇ s syndrome

目的利用磁共振波谱（MRS）研究图雷特综合征（Tourette’s syndrome，TS）患者双侧壳核的代谢改变，初步探讨其在中枢神经系统的潜在病因。方法收集22例TS患者及22名年龄性别相匹配的健康志愿者，常规行矢状位T1WI，轴位T1WI、T2WI扫描，另行横轴位3D三维扰像梯度回波序列扫描，对双侧壳核进行单体素氢质子MRS（1^H—MRS）采集，所测代谢物包括N-乙酰天冬氨酸（NAA）、胆碱（Cho）、肌酸（cr）以及肌醇（MI）。以Cr峰值作为参考值，根据峰下面积的大小分别计算NAA／Cr、Cho／Cr、MI／Cr的比值。结果与对照组（左侧：1．50±0．08，右侧：1．52±0．11）相比，TS患者双侧壳核NAA／Cr（左侧：1．29±0．13，T=1．962，P〈0．05；右侧：1．34±0．15，T=1．865，P〈0．05）明显减低，两者差异有统计学意义。两组资料相同解剖位置的组内及组间组内交互作用的NAA／Cr、Cho／Cr、MI／Cr比值差异均无统计学意义。结论双壳核神经元结构和（或）功能异常可能是TS的潜在的病因和病理生理基础之一。

Objective To study the changes of the putamen metabolites with magnetic resonance spectrum（MRS） , and to explore possible underlying unrecongnised aetiological factor and pathophysiology mechanism in the central nervous system of the patients with Tourette＇ s syndrome. Methods Twenty-two cases of Tourette＇ s syndrome, and twenty-two gender and age-matched subjects （the control subjects ） were performed on a clinical 3.0 T MRI system. Proton prob-voxel spectroscopy imaging （1^H-MRS） was obtained from two sides of the putamen. The metabolites included N-acetylaspartate （NAA）, creatine and phosphocreatine （Cr）, choline-containing compounds （Cho）, and myoinositol （MI）. The value of the NAA, Cr, Cho, and MI were calculated by integration of their peaks. The ratios of NAA/Cr,Cho/Cr, MI/ Cr were calculated respectively. Repeated measures analysis of variance （ANOVA） was used to test both the value of NAA/Cr, Cho/Cr, MI/Cr of the putamen for group difference, with group as between-subjects factor and side as within-subjects factor. Results The NAA/Cr ratio in patients （ left ： 1.29 ± 0. 13 ; right ： 1.34 ± 0. 15 ） was significantly lower than that in the control subjects （ left ： 1.50 ± 0. 08, T = 1. 962, P 〈 0. 05 ; right ： 1.52 ± 0. 11, T = 1. 865, P 〈 0. 05）. There was no significant difference in the Cho/Cr and MI/ Cr ratio between both groups. Conclusion The abnormalities of the structure and （or） function in the putamens of patients may be the one of the underlying anaetiological factors and pathophysiology mechanisms of the Tourette＇ s syndrome.