阻塞性睡眠呼吸暂停低通气综合征患者颞横回氢质子波谱研究

1 H Magnetic Resonance Spectroscopy Study of Auditory Cortex Metabolism in Patients with Obstructive Sleep Apnoea Hypopnea Syndrome

目的探讨磁共振氢质子波谱(1 H—MRS)用于阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者听皮层神经细胞损伤的预警作用。方法随机抽取经PSG监测确诊的OSAHS患者95例,根据纯音听阈将其分为OSAHS并双侧耳聋组(18例)、OSAHS并单侧耳聋组(27例,左15例,右12例)、单纯OSAHS组(50例),选择健康志愿者15例为正常对照组,各组分别行双侧颞横回听皮层1 H—MRS检测,根据神经代谢产物其峰下面积计算N-乙酰天门冬氨酸/肌酸(NAA/Cr)、胆碱/肌酸(Cho/Cr)、肌醇/肌酸(mI/Cr)、N-乙酰天门冬氨酸/胆碱(NAA/Cho);用ROC曲线面积>50%为判断上述各组指标诊断早期OSAHS并感音神经性听力损失的灵敏度及特异度。结果与正常对照组相比,OSAHS组以及OSAHS并耳聋组NAA/Cho降低(P<0.05),Cho/Cr、mI/Cr升高(P<0.05),OSAHS并双侧耳聋组NAA/Cho低于OSAHS组(P<0.05),而OSAHS并单侧耳聋组患侧与健侧NAA/Cho差异无统计学意义(P>0.05);NAA/Cho的ROC曲线下面积为73%,其余指标ROC曲线下的面积均<50%。结论 NAA/Cho有可能作为判定OASHS患者合并感音神经性听力损失的早期听皮层代谢预警指标。

Objective To investigate the characteristic changes of the metabolism products in auditory cortex （transverse temporal gyrus） in patients with OSAHS combined with nerve deafness using 1 H magnetic resonance spectroscopy （1 H - MRS） ,and to discovery the early warning indicator of nerve deafness in OSAHS .Methods PTA was performed in 95 patients with OSAHS （diagnosed by PSG） ,and 15 healthy control subjects ,the patients were classified into four groups ：the group of OSAHS ;OSAHS with unilateral and bilateral deafness ,the normal control group .Cerebral metabolism was studied by assessing the ratios of nitro -acetyl aspartate contrast to choline （NAA/Cho） as well as to creatine （NAA/Cr） ,myo -inositol to creatine （mI/Cr） and choline to creatine （Cho/Cr） ratios in the auditory cortical separately in these groups .ROC curves were made for those metabolism markers to find the best diagnositic threshold .Results Significantly lower values of NAA/Cho ratio were found in patients＆#39;（OSAHS with deafness） auditory cortex compared with 15 age-matched control subjects （P〈0 .05） and OSAHS without deafness （P〈0 .05） .Auditory cortical NAA and NAA/Cho ratio in OSAHS with unilateral nerve sensorineual hearing were significantly lower than those of in normal control （P〈0 .05） ,but there was no significant difference be-tween the abnormal and ontralateral normal auditory cortex by a self comparison .All of the metabolisms were tested＆amp;nbsp;by the curve of ROC .Conclusion Combined with the changes of metabolism ,and the curve of ROC ,NAA/Cho may be the early warning markers of sensorineual hearing was in OSAHS patients .