多域遗忘型轻度认知障碍与血管性非痴呆认知障碍的~1H-MRS分析

Hydrogen Proton Magnetic Resonance Spectroscopy in Multi Domain Amnestic Mild Cognitive Impairment and Vascular Cognitive Impairment without Dementia

目的探讨1H-MRS在多域遗忘型轻度认知障碍(M-a MCI)与血管性非痴呆认知障碍(VCIND)鉴别诊断中的应用价值。方法对30例M-a MCI、24例VCIND患者及20名认知功能正常老年人(NC组)行多体素1H-MRS检查,以左侧海马、扣带后回、额叶白质及侧脑室体旁白质为兴趣区,检测N-乙酰天门冬氨酸(NAA)、谷氨酸(Glu)、肌醇(m I)及肌酸(Cr)的峰下面积,比较三组间不同脑区NAA/Cr、Glu/Cr及m I/Cr比值的差异。结果 Ma MCI组及VCIND组左侧海马、扣带后回、额叶白质及侧脑室体旁白质区的NAA/Cr比值均较NC组降低,差异有显著性(P<0.05);但M-a MCI组和VCIND组在各脑区的NAA/Cr比值差异均无显著性(P>0.05)。M-a MCI组扣带后回Glu/Cr比值较VCIND组与NC组明显降低,差异有显著性(P<0.05);三组间的Glu/Cr比值在其他脑区差异均无显著性(P>0.05)。M-a MCI组在海马及扣带回的m I/Cr比值较VCIND组和NC组明显升高,差异有显著性(P<0.05);VCIND组在额叶白质区的m I/Cr比值较M-a MCI组升高,差异有显著性(P<0.05)。结论 M-a MCI及VCIND患者脑内m I及Glu代谢存在区域性的差异,1H-MRS是鉴别M-a MCI及VCIND的有效方法之一。

Objective The aim of this study was to investigate the value of hydrogen proton magnet resonance spectroscopy（1H-MRS） in the differential diagnosis of multi domain amnestic mild cognitive impairment（ M-a MCI） and vascular cognitive impairment without dementia（ VCIND）. Methods In 30 cases of M-a MCI,24 cases of VCIND,and 20 cases of elderly with normal cognitive function（ NC）,the regions of interest were examined,including the left hippocampus,the posterior cingulate gyrus,the frontal white matter,and the white matter adjacent to the lateral ventricles using multi voxel1H-MRS. The area under the peak was determined for N-acetyl aspartate（ NAA）,glutamate（ Glu）,inositol（ m I） and creatine（ Cr）. The ratios of NAA / Cr,Glu / Cr and m I / Cr in different brain regions were compared between the three groups. Results Compared with the NC group,the ratio of NAA / Cr in the left hippocampus,the posterior cingulate gyrus,the frontal white matter,and the white matter adjacent to the lateral ventricle was significantly lower in the M-a MCI and VCIND groups（ P 〈 0. 05）. However,no significant difference in the NAA / Cr ratio in any brain region were observed between M-a MCI and VCIND groups（ P 〉 0. 05）. The Glu / Cr ratio in the posterior cingulate gyrus of the M-a MCI group was significantly lower than in the VCIND and NC groups（ P 〈 0. 05）. No significant difference in the Glu / Cr ratio was found in other brain regions among the three groups（ P 〉 0. 05）. The m I / Cr ratio in the hippocampus and posterior cingulate gyri were significantly higher in the M-a MCI group than the VCIND and NC groups（ P 〈 0. 05）. The m I / Cr ratio in the frontal white matter of the VICND group was significantly higher than in the M-a MCI group（ P 〈 0. 05）. Conclusion Regional differences in m I and Glu metabolism were found in brain tissues of patients with M-a MCI and VCIND.1H-MRS is an effective method in the differential diagnosis of M-a MCI and VCIND.