初步探索用多体素质子磁共振波谱揭示CPAP治疗中重度OSAHS男性患者的疗效

Preliminary using multivoxel 1H-MRS to reveals the effect of CPAP treatment in moderate and severe OSAHS patients

目的用多体素质子磁共振波谱(1H magnetic resonance spectroscopy,1HMRS)探索阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者持续正压通气(continuous positive airway pressure,CPAP)治疗后的变化。材料与方法对25例中重度男性OSAHS患者的双侧额叶CPAP治疗前、治疗一天后及治疗90天后行头颅多体素1H-MRS检查,分别记录额叶各代谢物比值,比较两两之间的差异,并观察有无乳酸(lactate,Lac)峰出现。结果治疗后一天额叶N-乙酰天门冬氨酸(N-acetyl aspartate,NAA)/肌酸(creatine,Cr)、NAA/胆碱(choline,Cho)(分别为2.3140±0.3128和2.0164±0.4240)及治疗后90天(2.2812±0.2904和2.0180±0.4796)较治疗前(2.0284±0.2093和1.6088±0.2571)升高(P<0.05)。治疗一天后与治疗90天后的双侧额叶NAA/Cr、NAA/Cho值无明显变化。三者均未检测到Lac峰。结论 OSAHS患者CPAP前后脑代谢改变能被多体素1H-MRS敏感检测,为临床疗效及预后评估提供客观的影像学依据。

Objective： To investigate the variation of multivoxel 1H magnetic resonance spectroscopy（1H-MRS） after continuous positive airway pressure（CPAP） treatment in patients who are suffering from obstructive sleep apnea hypopnea syndrome（OSAHS）. Materials and Methods： Twenty-five cases of moderate or severe OSAHS patients were performed brain multivoxel 1H-MRS examinations before and after CPAP treatment. The ratios of brain metabolites in frontal lobe was recorded and analyzed respectively. To observe whether the lactate（Lac） peak appeared or not. Results： In region of frontal lobe, the NAA/Cr, NAA/Cho of the patients after treatment 1 day （2.3140±0.3128 and 2.0164±0.4240, respectively） and 90 days （2.2812±0.2904 and 2.0180±0.4796） were increased compared with the patients before treatment （2.0212±0.2312 and 1.6088±0.2571）, and the differences were statistically significant（P〈0.05）. Lac peak was not detected in all. Conclusion： Multivoxel 1H-MRS could demonstrate sensitively the changes of brain metabolism in patients with OSAHS before and after CPAP treatment, and may help clinical therapeutic effect and prognostic evaluation provide objective imaging evidence.