热射病患者小脑的磁共振波谱研究

Magnetic Resonance Spectroscopy Study of Cerebellum in Patients with Heat Stroke

目的应用磁共振波谱技术(MRS)探讨热射病(HS)患者小脑的代谢物变化。方法研究对象来源于2013年8月滨州医学院烟台附属医院重症医学科收治的8例HS患者和同期7名年龄相匹配的健康志愿者(对照组),采用化学位移成像采集MRS数据,测量HS患者及正常对照组小脑的代谢物比值NAA/Cr、NAA/Cr2、Cho/Cr、Cho/Cr2、NAA/Cho,采用Mann-Whitney U检验比较两组间MRS代谢参数之间的差异,HS患者小脑的代谢物比值并与Glasgow昏迷评分法(GCS)进行Pearson相关性分析。结果 HS患者小脑的NAA/Cr显著低于对照组(0.79±0.10 vs 1.03±0.11,P=0.004),Cho/Cr低于对照组(0.85±0.13 vs 0.99±0.05,P=0.032),NAA/Cr2、Cho/Cr2、NAA/Cho与对照组差异无统计学意义(均P>0.05);HS患者小脑的NAA/Cr与其GCS评分存在显著正相关(r=0.748,P=0.033)。结论应用MRS技术可敏感地探测HS患者小脑的代谢物异常,并可通过小脑的代谢物比值NAA/Cr判断病情的轻重。

Objective By using magnetic resonance spectroscopy （MRS） to investigate the changes in metabolites of cerebellum in patients with heat stroke. Methods In August 2013 eight patients with heat stroke （study group） were ad- mitted to Intensive Care Unit, Affiliated Yantai Hospital, Binzhou Medical College. Other seven age-matched healthy vol- unteers （control group） were recruited during the same summer season. Using multi-voxel chemical shift imaging, the MRS data acquisition was performed. The cerebellar metabolite ratios, including N-acetyl aspartate/creatine ratio （NAA/Cr）, N-acetyl aspartate/creatine2 ratio （ NAA/Cr2）, choline/creatine ratio （ Cho/Cr）, choline/creatine2 ratio （Cho/Cr2） and N-acetyl aspartate/choline ratio （NAA/Cho） , were estimated in all examinees. The Mann-Whitney U test was used to compare the differences in metabolic parameters between the two groups. Pearson correlation analysis of NAA/Cr and the Glasgow Coma Scale （GCS） in patients with heat stroke was carried out. Results The ratio of NAA/Cr and Cho/Cr in cerebellum in the study group were significantly lower than those in the control group （ 0.79 ± 0.10 vs 1.03 ± 0.11, P = 0.004 ; and 0.85 ± 0.13 vs 0.99 ± 0.05, P = 0. 032 ; respectively）. No statistically significant differences in the ratios of NAA/Cr2, Cho/Cr2 and NAA/Cho existed between the study group and the control group （P 〉 0.05 in all）. In patients with heat stroke, the ratio of NAA/Cr in cerebellum bore a parallel correlation with GCS score （ r = 0. 748, P = 0. 033 ）. Conclusion MRS can sensitively detect the abnormality of metabolites in cerebellum in patients with heat stroke, and the ratio of NAA/Cr can be used in judging the severity of the illness.