质子磁共振波谱在轻度认知功能障碍诊治中的应用研究

Clinical application of proton magnetic resonance spectroscopy in mild cognitive impairment

目的:探讨质子磁共振波谱(1H-MRS)在轻度认知功能障碍(MCI)诊断与治疗中的应用价值。方法:选择40例轻度认知功能障碍(MCI)患者,随机分为实验组20例和对照组20例。所有病例入组时检测简易精神状态检查表(MMSE)、采用1H-MRS技术,检测海马、扣带后回、顶叶等部位,指标为NAA、mI、Cho、Cr,计算NAA/Cr、NAA/mI、Cho/Cr比值,实验组予胆碱酯酶抑制剂石杉碱甲片口服,0.1 mg,一日2次,疗程为6个月,对照组不给予痴呆治疗药物。治疗结束后观察MMSE评分及MRS各项检测指标的变化,并随访1年,统计MCI转化为痴呆的比率。随访结束后,将对照组分为已转化痴呆组与未转化痴呆组两个亚组,回顾性分析两个亚组入组时海马、扣带后回、顶叶等部位NAA/Cr、NAA/mI、Cho/Cr等指标的差异。结果:治疗后实验组MMSE评分增加,与对照组比较差异有统计学意义(P<0.01)。治疗后实验组海马、扣带后回、顶叶的NAA/Cr、NAA/mI、Cho/Cr等指标的变化,与对照组比较差异有统计学意义(P<0.01)。随访转化为痴呆的比率,实验组低于对照组,但差异没有统计学意义(P>0.05)。随访结束后对照组亚组分析,入组时已转化痴呆组海马、扣带后回NAA/Cr、NAA/mI低于未转化痴呆组、Cho/Cr高于未转化痴呆组,差异有统计学意义(P<0.01),以扣带后回差异最为明显。结论:质子磁共振波谱检测扣带后回发现NAA下降、mI及Cho升高,NAA/Cr、NAA/mI比值下降与Cho/Cr比值升高,有助于痴呆的早期诊治。

Objectives： To explore the diagnosis and therapeutic value of Magnetic resonance spectroscopy（ 1 H-MRS） in mild cognitive impairment（MCI）.Methods： From June 2009 to June 2012,40 patients with MCI treated in our hospital were selected and randomized into 2 groups： experiment group and control group,each 20 cases.All cases were evaluated by mini-mental state examination（MMSE） and executed 1 H-MRS at the hippocampus,posterior cingulate gyrus,parietal lobe to get the index of NAA / Cr、NAA / mI、Cho / Cr before and after experiment.Cholinesterase inhibitor Huperzine A Tablets were applied for experiment group（0.1 mg,twice a day,6 months）,while therapeutic drug against dementia absenced in control group.Dement rate from MCI was calculated after 1 year follow-up,and the difference of NAA / Cr、 NAA / mI、Cho / Cr between the two subgroup（demented or not） in control group were analyzed.Results： Mean MMSE score increased after treatment in the experiment group,and was significant vs control group（P 0.01）.The changes of NAA / Cr、NAA / mI、Cho / Cr at the hippocampus,posterior cingulate gyrus,and parietal lobe in experiment group after treatment was significant with control group（P 0.01）.Dement rate from MCI after follow-up was lower in experiment group than in control group,but no significant difference between them（P 0.05）.Subgroup analysis of control group after follow-up showed that NAA / Cr、NAA / mI at hippocampus,cingulate gyrus was lower in demented patients than in undemented patients,and Cho / Cr reversed（all P 0.01）.The difference manifested in posterior cingulate gyrus.Conclusions： It is helpful for diagnosis and treatment of dementia to use 1 H-MRS checking the NAA / Cr,NAA / mI,Cho / Cr at the posterior cingulate gyrus.