军人PTSD患者治疗前后磁共振质子波谱的变化特点

Changes in proton magnetic resonance spectroscopy in soldiers before and after treatment of posttraumatic stress disorder

目的观察军人创伤后应激障碍患者前额叶质子波谱的特点及与临床疗效的关系。方法对23例军人PTSD患者在入院24 h内行前额叶氢质子磁共振波谱(1H-MRS)扫描,并随机抽取某部25例健康官兵作为对照组。测定两组前额叶N-乙酰基天门冬氨酸(NAA)、谷氨酰胺复合物(CLx)、胆碱复合物(Cho)、肌醇(m I)、肌酸复合物(Cr)等化合物的含量,并观察其与临床疗效的关系。结果军人PTSD患者治疗前左侧前额叶NAA/Cr1.34±0.42、右侧1.36±0.48,正常对照组分别为1.58±0.64和1.55±0.59(P<0.01);研究组治疗前左侧前额叶Cho/Cr与对照组存在显著性差异(1.23±0.36 vs 1.14±0.31,P<0.05),而右侧差异无统计学意义(P>0.05);研究组治疗前后、对照组CLx、m I含量无显著性差异(P>0.05);研究组治疗前后左侧前额叶NAA/Cr(1.34±0.42 vs 1.49±0.52),存在显著性差异(P<0.05)。研究组治疗前后左侧前额叶NAA/Cr、Cho/Cr和右侧前额叶NAA/Cr与简明精神病评定量表(BPRS)评分减分值存在显著相关性(P<0.05)。结论军人PTSD患者双侧前额叶均存在NAA/Cr、Cho/Cr等代谢物质的改变,且与患者精神症状的严重程度密切相关,PTSD患者前额叶NAA/Cr、Cho/Cr的改变,可能是PTSD的发病机制之一。

Objective To study the relationship of proton magnetic resonance spectroscopy and clinical efficacy in soldiers post-traumatic stress disorder （PTSD）. Methods Proton magnetic resonance spectroscopy （1H-MRS） scan to 23 soldiers with PTSD within 24 hours admitted in hospital,and 25 health soldiers were randomly selected as the control group. N-acetyl groups prefrontal yl aspartate （NAA）,glutamine compound （CLx）,choline （Cho）,inositol（mI）,creatine compound（Cr） compound were detected,and its relationship with clinical efficacy was observed. Results Patients treatment PTSD before with the left prefrontal NAA/Cr was 1.34±0.42,the right side was 1.36±0.48,normal control group were 1.58±0.64 and 1.55±0.59（P〈0.01）. Study group before treatment the left frontal Cho/Cr compared with control group had a significant difference （1.23±0.36 vs 1.14±0.31,P〈0.05）,whereas no significant difference between the right side （P〉0.05）. Study group before and after treatment which the Clx and mI showed no significant difference （P〉0.05）. There was a significant difference （P〈0.05） in the left frontal NAA/Cr （1.34±0.42 vs 1.49±0.52） of the study group before and after treatment. Before and after treatment study group left frontal NAA/Cr,Cho/Cr and right prefrontal NAA/Cr and the Brief Psychiatric Rating Scale （BPRS） score had significantly reduced scores correlated （P〈0.05）. Conclusion Soldiers with PTSD exist bilateral prefrontal change of NAA/Cr,Cho/Cr and other metabolites,which is related closely to the severity of psychotic symptoms in patients with right prefrontal patients PTSD NAA/Cr,Cho/Cr. The change may be one of the pathogenesis of PTSD.