骨骼肌失神经损伤的单体素质子波谱应用研究

Application of Proton Magnetic Resonance Spectroscopy（^1H-MRS） in Patients with Denervated Skeletal Muscle Injury

目的 研究健康人群及骨骼肌失神经损伤患者的单体素质子波谱（^1H．MRS）各代谢物分布及其变化规律，初步探讨。H-MRS在骨骼肌失神经损伤中的应用价值。方法搜集16名健康志愿者及19例尺神经损伤患者（男16例，女3例，年龄16～57岁）。所有志愿者及患者均采用相同方法对尺神经支配的第一骨间背侧肌行^1H—MRS检测。最后将^1H—MRS检查所得各代谢物含量数据进行统计学分析。结果损伤侧组骨骼肌细胞内脂质（IMCL）含量及其相对含量的总体秩和分别为507．5和498，健侧组分别为233．5和243；损伤侧组骨骼肌细胞外脂质（EMCL）含量及相对含量的秩和分别为490和477，健侧组分别为251和264；损伤侧组肌酸含量的秩和为475，健侧组秩和为266。以上各组间均存在统计学差异（P〈0．05）。另外，损伤组IMCL、EMCL含量及各自相对含量与志愿者组相比较也存在相似的统计学差异（P〈0．05），肌酸含量在损伤组与志愿者组之间也存在统计学差异（P〈0．05）。结论^1H-MRS技术可以较好地区分开IMCL及EMCL。IMCL于失神经损伤早期具有重要辅助诊断价值，EMCL对骨骼肌失神经损伤的远期诊断及动态监测可能价值较大。

Objective To evaluate the distribution and spectrum of metabolites of patients with denervated skeletal muscle injury with Single voxel proton MR spectroscopy. Methods 16 asymptomatic volunteers （ n = 16） of age from 22 to 54 years and 19 cases（ n = 19） of different degrees of injury of the ulnar nerve（ including 3 females and 16 males） which aged from 16 to 57years were collected. All the volunteers and patients were tested by the same methods that the metabolites of target muscle were measured respectively with the application of single voxel proton MR spectroscopy. The final data was analyzed with statistic software. Results The rank sum of the content and relative content of intramyocellular lipids （IMCL） of injured side group were 507.5 and 498 respectively, and the rank sum of health side group were 233.5 and 243. The same statistical indicators of extramyocellalar lipids （EMCL） between injured side group and health side group were as follows respectively： 490,477 and 251, 264. The rank sum of the content of creatine between injured side group and health side group were 475 and 266 respectively. There were statistical differences in each group above all（ P 〈 0.05 ）. There were the same statistical differences between injured group and volunteer group. Conclusion Single voxel proton magnetic resonance spectroscopy （^1H-MRS ） technology can be used to distinguish the IMCL and EMCL. Meanwhile, 1HMRS detect that IMCL raises early in nerve injury, so IMCL has important diagnostic value in early phase of denervated muscle injury, and EMCL has long term diagnostic value and dynamic monitoring value of denervated skeletal muscle injury.