多体素磁共振频谱技术定量评估系统性红斑狼疮患者颅内代谢物

Quantitative analysis of brain metabolites in systemic lupus erythematosus patients using multivoxel MR spectroscopy

目的探讨神经精神狼疮（NPSLE）和无神经精神症状的系统性红斑狼疮（non．NPSLE）患者颅内不同脑区的代谢物绝对浓度变化特征，及其与认知功能的关系。方法对22例NPSLE患者、21例non-NPSLE患者及20名健康志愿者（健康对照组）行常规MRI及多体素磁共振频谱扫描，联合LCModel与SAGE软件定量分析3组间双侧扣带回后部（PCG）、双侧背侧丘脑（DT）、双侧豆状核（LN）、双侧侧脑室后角旁白质（PWM）的N-乙酰基天门冬氨酸（NAA）、胆碱、总肌酸（tCr）、肌醇及谷氨酸＋谷氨酰胺（Glx）绝对浓度，并分析其与认知功能评分的相关性。采用矿检验，校正t检验，Spearman秩相关进行统计分析。结果①与健康对照组相比，NPSLE组NAA浓度在双侧PCG和DT降低，在右侧PCG、左侧PCG、右侧DT、左侧DT，二者的均数差值分别为-1．504[95％可信区间（CI）（-2．335，-0．672），P=0．001]、-1．460[95％CI（-2．349，-0．570），P=0．002]、-1．259195％CI（-1．894，-0．625），P=0．000]和-1．022195％CI（-1．688，-0．356），P=0．003]；tCr浓度在右侧PCG和右侧DT降低，其均数差值分别为-1．094[95％CI（-1．845，-0．342），P=0．003]和-0．955[95％CI（-1．630，-0．280），P=0．006]；Glx浓度在右侧DT降低，均数差值为-2．586[95％CI（-4．139，-1．033），P=0．002]。②与non-NPSLE组相比，NPSLE组NAA浓度在左侧PCG降低，均数差值为-1．256195％CI（2．146，-0．367），P=0．006]。③在双侧PCG，简易智能评分（右侧PCG：rs=0．312，P〈0．05；左侧PCG：rx=0．355，P〈0．05）、蒙特利尔认知评分（右侧PCG：rs=0．362，P〈0．01；左侧PCG：rs=0．285，P〈0．05）与NAA浓度呈正相关关系。结论NPSLE和non-NPSLE患者颅内不同区域代谢物的异常分布，为两者的临床鉴别诊断提供了一定的影像学依据。另外，SLE患者出现认知功能下降在一定程度可能是由扣带回后部神经元损伤引起。

Objective To investigate the metabolite changes in systemic lupus erythematosus （SLE） patients with and without nerropsychiatric symptoms using magnetic resonance spectroscopy （MRS） and explore the associations between image findings and chmcal variables. Methods Twenty-two SLE patients with neuropsychiatric symptonls （NPSLE）, twenty-one SLE patients without neuropsyehiatric symptoms （non-NPSLE） and twenty healthy eontrols （HCs） underwent routine MRI scan and multivoxel magnetic reson-ance spectroscopy （MVS）. The absolute metabolite concentrations were measured bilaterally in the posterior cingulate gyrus （PCG）, dorsal thalamus （DT）, lentiform nucleus （LN） and posterior paratrigonal white matter （PWM） using LCModel and SAGE software. The relationships between metabolite con-centrations and cognitive function scores were analyzed by Spearman rank correlation. Single-factor Chi-square analysis and t-test were used for analysis. Results ①Compared to control subjects, NPSLE patients had significantly lower N-acetylaspartate （NAA） values in bilateral PCG and DT, with the mean differences of -1.504 [95% confidence interval （CI） （-2.335, -0.672）, P=0.001], -1.460 [95% CI （-2.349, -0.570）, P=0.002], -1.259 [95% CI （-1.894, -0.625）, P=0.000] and -1.022195%CI （-1.688, -0.356）, P=0.003] for RPCG, LPCG, RDT and LDT, respectively. The concentration of total creatinine were observed to decline in RPCG and RDT, with the mean differences of -1.094 [95% CI （-1.845, -0.342）, P=0.003], -0.955 [95% CI （-1.630, -0.280）, P=0.006], -1.259 [95% CI （-1.894,-0.625）, P=-0.006] respectively. Glutamine and glutamate-values decreased significantly in RDT [mean difference=-2.586, 95%C1 （-4.139, -1.033）, P=0.002].② Compared to non-NPSLE patients, NPSLE patients had a lower NAA level in LPCG [mean difference=-l.256, 95% CI （-2.146, -0.367）, P=0.006]. Positive correlations between mini-mental state examination scores [RPCG： rs=0.312, P〈0.05; LPCG： rs=0.355, P〈0.01], Montreal cognitive assessment scores （RPCG： rs=0.362, P〈0.01; LPCG： rs=0.285, P〈0.05） and NAA values in bilateral PCG were detected. Conclusion Both NPSLE and non-NPSLE patients may have metabolite dysfun-ctions in different brain regions. The cognitive disorder in SLE patients may be interpreted by neuronic damage of PCG.