阿尔茨海默病氢质子MR波谱研究的Meta分析

Measurement of brain metabolites by ^1H.MR spectroscopy in patients with Alzheimer disease： a Meta analysis

目的用Meta分析的方法综合评价。H-MRS相对定量指标与阿尔茨海默病（AD）的关系。方法检索美国医学索引（Medline）、中国期刊网（CNKI）及中华医学会数字化期刊数据库有关^1H—MRS评价AD的中英文文献。提取文献中AD患者和正常对照组用相对定量指标[N-乙酰天冬氨酸（NAA）／肌酸（Cr）、胆碱（Cho）／Cr、肌醇（mI）／Cr]对不同脑区（海马、扣带回后部、颞叶、顶叶、额叶、枕叶）的测量数据，同时进行文献的质量方法学评估。用Meta分析软件（ReviewManager4．2）对纳入文献汇总分析，获得汇总加权均数差（WMD）及95％可信区间（95％CI），并对不同脑区NAA／Cr和mI／Cr的WMD值进行线性相关分析。结果共纳入文献36篇（英文27篇，中文9篇）。通过异质性检验，分别采用固定效应模型或随机效应模型进行分析。AD组NAA／Cr水平低于对照组，汇总WMD及95％CI为-0．14（-0．17～-0．11），AD组mI／Cr水平高于对照组，汇总WMD及95％CI为0．10（0．07—0．13）；海马是两指标差异最显著的部位，其中，海马处NAA／Cr的汇总WMD及95％CI为-0．27（-0．36～0．19，P〈0．01），海马处mI／Cr的汇总WMD及95％CI为0．21（0．10～0．33）（P〈0．01）；而AD组与对照组间Cho／Cr水平差异无统计学意义，总体的汇总WMD值及95％CI为0．01（0．00～0．01）（P〉0．05）。通过相关分析，脑区间NAA／Cr和MI／Cr的WMD的变化趋势具有正相关性（r=0．947，P〈0．05）。结论海马区可能是AD受累最显著的部位，NAA／Cr、MI／Cr的变化能够反映AD病理生理过程。

Objective To have a systemic review of the association between relative ratio in proton magnetic resonance spectroscopy （ ^1H-MRS） and Alzheimer＇ s disease （ AD ）. Methods A search in Medline and China National Knowledge Infrastructure （CNKI） was performed, and relevant English and Chinese-language articles about assessing AD with ^1H-MRS were identifed. The data of relative metabolic ratios （ NAA/Cr, Cho/Cr, mI/Cr） from different brain regions （ hippocampus, posterior cingulate gyrus, temporal lobe, parietal lobe, frontal lobe, occipital lobe） were extracted from the articles. The quality of the articles was evaluated according to the standard recommended by Newcastle-Ottawa criteria. The Meta-analysis was done with the Review Manager 4. 2 to calculate pooled weighted mean difference （WMD） with 95% confidence interval （95% CI） , and linear correlation analysis between NAA/Cr ratio and mI/Cr ratio was done by SPSS 17. 0. Results Thirty six articles （27 English articles, 9 Chinese articles） were included. After heterogeneity test was done, fixed effects model or random effects model was selected. The meta-analysis showed that the NAA/Cr ratio in patients with AD was higher than that in controls （WMD： -0. 14,95%CI： -0. 17 to -0. 11）. The ml/Cr ratio in patients with AD was lower than that in controls （ WMD： 0. 10,95%CI：0. 07 to 0. 13）. There were greatest changes in NAA/Cr ratio and mI/Cr ratio on the hippocampus （WMD of NAA/Cr： - 0. 27,95% CI： - 0. 36 to - 0. 19; WMD of ml/Cr：0. 21, 95% CI： 0. 10 to 0. 33）. There were also no differences between patients with AD and controls with respect to the MI/Cr might reflect the neurodegenerative process of AD