急性脑梗死患者氢质子磁共振波谱分析

Study of acute cerebral infraction using proton magnetic resonance spectroscopy

目的:探讨氢质子磁共振波谱(1H-MRS)在急性脑梗死中的临床应用价值。方法:在脑梗死后12h内,对47例脑梗死患者行常规MRI、弥散加权成像(DWI)及1H-MRS检测。所有患者均住院接受2周正规内科治疗,1～2个月后复查头颅1H-MRS。分别比较梗死灶中心、梗死灶-正常组织交界区与其对侧相同部位,同一部位不同时间点的代谢物[N-乙酰天门冬氨酸(NAA)、总肌酸(肌酸+磷酸肌酸)(Cr)、胆碱化合物(Cho)及乳酸(Lac)]含量的差异。结果:47例脑梗死患者病后各期均出现NAA、Cho及Lac3种代谢物改变。梗死灶中心在发病后12h内NAA/Cr及NAA/Cho值降低(t=2.593,P=0.011;t=2.630,P=0.010),Lac/Cr值升高(t=5.478,P<0.001);与发病6h内相比,6～12h内Lac/Cr值升高(t=2.598,P=0.011),NAA/Cho值降低(t=2.337,P=0.022);1～2个月后NAA/Cr、NAA/Cho、Cho/Cr及Lac/Cr值均降低(P<0.05)。交界区发病12h内出现Lac/Cr升高(t=25.720,P<0.001),并在1～2个月后下降(t=9.875,P<0.001),而NAA/Cr、NAA/Cho及Cho/Cr值未改变(P>0.05)。与未溶栓组相比,溶栓组1～2个月后交界区NAA/Cr、NAA/Cho及Cho/Cr值均增高(P<0.05),而梗死区中心MRS值差异均无统计学意义(P>0.05)。结论:1H-MRS可提供脑梗死区的代谢变化信息,推断脑梗死后病理生理变化,对评估脑梗死程度及治疗效果具有重要作用。

Aim：To explore the clinical role of 1H-MRS in acute cerebral infraction.Methods：Forty-seven patients with stroke underwent routine MRI,diffusion weighted imaging（DWI） and multiple-voxel 1H-MRS examination within 12 hours after stroke.All patients received normal regular medical treatment for two weeks,and underwent follow-up 1H-MRS examination during 1 to 2 months after stroke.The metabolic alterations in the infraction center,the border region,and their contralateral parts were analyzed.Results：All 47 patients experienced changes in NAA,Cho and Lac at different stages after cerebral infraction.In the infraction center（IC）,we observed that NAA/Cr and NAA/Cho decreased（t = 2.593,P = 0.011;t = 2.630,P =0.010）,Lac/Cr increased（t =5.478,P 〈0.001）.Compared those with in 6 h after stroke,we found Lac/Cr increased（t =2.598,P =0.011）,NAA/Cho decreased（t =2.337,P =0.022） within 6 to 12 h after stroke in the IC.During 1 to 2 months post stroke,we found significant decreases in NAA/Cr,NAA/Cho,Cho/Cr and Lac/Cr（P 〈0.05） in the IC.In the broader areas,we found that Lac/Cr increased significantly at 12 h（t =25.720,P 〈0.001） and decreased during 1 to 2 months after stroke（t = 9.875,P 〈 0.001）,but there were not significant changes in NAA/Cr,NAA/Cho and Cho/Cr（P〉0.05）.Compared with the patients without thrombolysis,significant increases in NAA/Cr,NAA/Cho and Cho/Cr in the broader areas at 1 to 2 months in patients receiving thrombolysis（P 〈0.05）,but there were no notable changes in NAA/Cr,NAA/Cho and Cho/Cr in the IC（P 〉0.05）.Conclusion：1H-MRS could depict the metabolic changes indicating the pathophysiological process associated with stroke,and could be used to assess the injury severity and treatment effectiveness.