麻痹性痴呆患者海马磁共振波谱研究

Study of hippocampus magnetic resonance spectroscopy on patients with general paresis of the insane

目的探讨麻痹性痴呆(GPI)患者海马代谢物的变化及磁共振波谱(MRS)对GPI的诊断价值。方法对18例GPI患者(GPI组)、18例无神经系统损害的梅毒患者(普通梅毒组)及20例健康志愿者(对照组)行常规MRI检查,并予以行双侧海马1H-MRS单体素扫描,测量双侧海马N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌酸和磷酸肌酸(Cr)和肌醇(MI)的峰下面积,计算NAA/Cr、MI/Cr和Cho/Cr,并比较3组间的差异。结果与对照组比较,GPI组双侧海马NAA/Cr明显降低(均P<0.01),MI/Cr明显升高(均P<0.05);与普通梅毒组比较,GPI组双侧海马NAA/Cr明显降低(均P<0.01),MI/Cr明显升高(均P<0.05);而普通梅毒组与对照组比较,各个数据之间无显著性差异(均P>0.05)。结论1H-MRS能有效检测GPI患者脑组织物质代谢变化,提示GPI患者海马神经元活性降低、丢失明显,并可能伴有神经胶质细胞的增生;对GPI的诊断提供重要依据。

Objective To investigate the changes of hippocampal metabolites in general paresis of the insane（ GPI） and the diagnostic value of magnetic resonance spectroscopy（ MRS） for GPI. Methods Eighteen GPI patients（ GPI group）,18 syphilis patients without nervous system damage（ general syphilis group） and 20 healthy volunteers（ control group） underwent conventional MRI for brain and shall be scanning the single voxel of1H-MRS for bilateral hippocampal,measuring the area under the peak for bilateral hippocampal N-acetyl aspartic acid（ NAA）,choline compound（ Cho）,creatine and phosphocreatine（ Cr） and inositol（ MI）,calculating the ratio of NAA / Cr,MI / Cr and Cho / Cr,the results were compared between 3 groups. Results Compared with control group,NAA / Cr in the bilateral hippocampal in GPI group was significantly decreased（ all P〈0. 01）,MI / Cr was significantly increased（ all P〈0. 05）. Compared with general syphilis group,NAA/Cr in bilateral hippocampal in GPI group was significantly decreased（ all P〈0. 01）,MI / Cr was significantly increased（ all P〈0. 05）. There was no significant difference between general syphilis group and control group（ all P〈0. 05）. Conclusions1H-MRS can effectively detect changes of substance metabolism in the brain in GPI patients,indicate the activity of hippocampal neurons in GPI patients were obviously reduce or loss,and may be accompanied by glial cell proliferation. It can provide an important basis for diagnosis of GPI.