首发脑梗死患者认知功能与^1H-MRS的相关性研究

Correlation of ^1H-MRS findings with cognition function in patients with first cerebral infarction

目的探讨首发脑梗死患者认知功能与左前额叶白质氢质子磁共振波谱（1H- MRS）、日常生活能力量表（ADL）的关系。方法对38例首发脑梗死患者在发病1周内、3个月末、6个月末检测左前额叶白质1H- MRS中的氮-乙酰门冬氨酸（NAA）、胆碱（Cho）、肌酐（Cr），同时进行中文版蒙特利尔认知评估量表（MoCA）、ADL评分。按MoCA结果分为脑梗死后血管性认知功能损害（VCI）组、正常组、变化组，分析3组间各时间点1H- MRS（Cho、Cho/Cr、NAA、NAA/Cr）、ADL的差异。结果3个月末VCI组与变化组各1H- MRS差异均有统计学意义（均P＜0.05），VCI组与正常组各1H- MRS差异均有统计学意义（P＜0.01或0.05）；6个月末VCI组与正常组、变化组各1H- MRS差异均有统计学意义（P＜0.01或0.05）。1周内、3个月末VCI组与正常组的ADL评分差异均有统计学意义（P＜0.01或0.05）；3个月末VCI组与变化组的ADL评分差异有统计学意义（P＜0.05）；6个月末VCI组与变化组、正常组ADL评分差异均有统计学意义（均P＜0.01）。结论首发脑梗死后VCI患者左前额叶白质1H- MRS出现变化，3个月末的1H- MRS对VCI的转变有预测价值。

Objective To investigate the correlation of proton magnetic resonance spectroscopy （1H- MRS） findings in the left frontal white matter with cognition function and ability of daily life（ADL） in patients with first cerebral infarction. Methods Thirty eight patients with first cerebral infarction（onset within 7d） were enrol ed in this study. 1H- MRS in left frontal white matter was per-formed and N- acetyl aspartic acid（NAA）, choline（Cho）, creatinine（Cr） were documented;Montreal Cognitive Assessment （Mo-CA）and ADL assessment were conducted within the 1st week and repeated at 3 and 6 months after onset. MoCA results were classified as vascular cognitive impairment （VCI） , normal cognition and changed cognition. The correlation of 1H- MRS findings （Cho ,Cho/Cr ,NAA,NAA/Cr ） with ADL, was analyzed in 3 groups at different time points. Results There were significant differ-ences in 1H- MRS findings between VCI and normal, changed cognition groups both at 3 months and 6 months after cerebral in-farction （P〈0.01 or 0.05）. There were significant differences in ADL scores between the VCI group and normal group both within 7d and at 3 months and 6 months after onset （P〈0.01 or 0.05）;there was significant difference in ADL scores between the VCI group and changed group at 3 months and 6 months after onset （P〈0.05 or 0.01）. Conclusion changes in the left frontal white matter and also predict the transition of VCI for patients with first cerebral infarction and vascular cognition impairment. 1H- MRS can demonstrate changes in the left frontal white matter and also predict the transition of VCI for patients with first cerebral infarction and vascular cognition impairment.