阿尔茨海默病患者神经心理学改变与氢质子磁共振波谱相关性研究

Relationship between neuropsychological changes and proton magnetic resonance spectroscopy in patients with Alzheimer disease

目的 分析不同痴呆程度阿尔茨海默病（AD）患者神经心理学改变与氢质子磁共振波谱（1H-MRS）之间的相关性.方法 按AD诊断标准、临床痴呆评定量表（CDR）纳入AD患者30例,分为轻度痴呆组、中度痴呆组、重度痴呆组,每组10例.对每例AD患者进行简易智能状态检查量表（MMSE）、日常生活能力量表（ADL）、社会功能活动量表（FAQ）、WAIS数字广度测验（DST）评定.采用1H-MRS分析技术测定双侧海马区N-乙酰天门冬氨酸（NAA）/肌酸（Cr）比值和胆碱（Cho）/肌酸（Cr）比值.结果 3组之间NAA/Cr比值差异有统计学意义（P〈0.05或P〈0.01）,随着痴呆程度加重,NAA/Cr比值逐渐减低.轻度痴呆组、重度痴呆组左侧海马区NAA /Cr比值与MMSE评分及DST评分呈显著正相关（r1=0.716、r2=0.640、r3=0.717、r4=0.766,P〈0.05）;中度痴呆组右侧海马区NAA /Cr比值与MMSE评分呈显著正相关（r=0.831,P〈0.05）;3组双侧海马区Cho /Cr比值与各量表评分均无明显相关性.结论 AD患者随着病情加重海马区代谢物NAA /Cr比值逐渐减低;海马区代谢物NAA /Cr比值变化可作为AD早期诊断、病情评估及病程监测的生物学指标.

Objective To analysize the relationship between neuropsychological changes and proton magnetic reso-nance spectroscopy （ ^1 H - MRS） in patients with Alzheimer disease （AD）. Methods According to the diagnostic crite-ria and clinical dementia rating （CDR） , 30 patients with AD were assigned to 3 groups （n = 10 each） - - mild AD group （mild group）, moderate AD group （moderate group）, and severe AD group （severe group）. All the patients in each group were assessed by mini-mental state examination （MMSE） , activities of daily living （ADL）, functional ac-tivities questionnaire （FAQ）, and WAIS digit span test （DST）. At the same time, the ratios of N - acetylaspartate （ NAA）/ereatine （ Cr）, choline （ Cho）/ereatine （Cr） of bilateral hippoeampus were determined by ：H - MRS. Results The ratios of NAA/Cr among 3 AD groups were significantly different （ P 〈 0.05 or P 〈 0.01 ） , which declined with the aggravation of dementia. In mild group and severe group, the ratios of NAA/Cr of the left hippoeampus had significant positive correlation with the scores of MMSE and DST （ r1 = 0. 716, r2 = 0. 640, r3 = 0. 717, r4 = 0. 766, P 〈 0.05）. In the moderate group, the ratios of NAA/Cr of the right hippocampus remarkably cmxelated with the scores of MMSE （ r = 0. 831, P 〈0.05）. The ratios of Cho/Cr of bilateral hippocampus had nothing to do with the scores of either scale in each group. Conclusion The ratios of NAA/Cr of the hippoeampus in AD patients decline continuously with the aggra-vation of dementia. Besides, the change of ratios of NAA/Cr in the hippoeampal region can be regarded as a biological parameter in the early diagnosis, pathogenic condition evaluation, and disease monitoring of AD.