麻痹性痴呆与阿尔茨海默病患者海马区氢质子磁共振波谱特点

Hydrogen proton magnetic resonance spectroscopy of hippocampus of patients with general paresis of insane and Alzheimer＇s disease

目的 应用氢质子磁共振波谱（1 H-MRS）技术,探索麻痹性痴呆（GPI）患者、阿尔茨海默病（AD）患者和健康中老年人海马区代谢物水平特点.方法 纳入GPI患者35例,AD患者27例,健康中老年对照38名进行双侧海马区1 H-MRS检查,比较N-乙酰天门冬氨酸（N-acetylaspartate,NAA）/肌酸、胆碱/肌酸,NAA/胆碱,胆碱/NAA和肌醇/肌酸的水平;并同日进行简易精神状态检查（MMSE）、蒙特利尔认知检查量表（MoCA）评定,探索GPI、AD患者海马区代谢物水平与病程严重程度的相关性.结果 GPI、AD组双侧海马区的NAA/肌酸均显著低于健康对照组（左侧1.48 ±0.25、1.52±0.28和1.71 ±0.36,F=5.928,P=0.004;右侧 1.47±0.38、1.62±0.36和1.82±0.42,F=7.309,P=0.001）,GPI组右侧海马区的胆碱/NAA （0.68±0.48）显著高于AD组（0.49 ±0.15）和健康对照组（0.53±0.14）,差异有统计学意义（P =0.024,P=0.045）.GPI组和AD组海马区各代谢物水平与MMSE、MoCA评分均无显著相关.结论 GH和AD患者均存在双侧海马区神经元损伤.

Objective To investigate the characteristics of hydrogen proton magnetic resonance spectroscopy （1H-MRS） in bilateral hippocampus in patients with general paresis of insane （GPI） and Alzheimer＇s disease （AD）.Methods The metabolic ratios of N-acetylaspartate/creatine （NAA/Cr）,choline （Cho）/Cr,NAA/Cho,Cho/NAA and myo-inositol （mI）/Cr in bilateral hippocampus were determined by 1 H-MRS in 35 patients with GPI,27 patients with AD and 38 normal controls （NC）,and the Mini-Mental State Examination （MMSE） and Montreal Cognitive Assessment scale （MoCA） scores were evaluated on the same day.Results The NAA/Cr in bilateral hippocampus of patients with GPI and AD was significantly lower than that of the NC （left：1.48 ± 0.25,1.52 ± 0.28 and 1.71 ± 0.36,F =5.928,P =0.004;right：1.47 ±0.38,1.62 ±0.36 and 1.82 ±0.42,F =7.309,P =0.001）.The Cho/NAA in right hippocampus of patients with GPI （0.68 ± 0.48） was significantly higher than that of the AD patients （0.49 ± 0.15） and NC （0.53 ± 0.14,P =0.024,P =0.045）.There was no significant correlation between the metabolic ratios in bilateral hippocampus of patients with GPI and AD and the scores of MMSE and MoCA.Conclusion Patients with GPI and AD have neuronal dysfunction in bilateral hippocampus.