海马区的磁共振波谱成像在睡眠呼吸暂停综合征患者的表现

Magnetic Resonance Spectroscopy of Hippocampus in Sleep Apnea Syndrome

目的通过横断面研究分析海马区的磁共振波谱(MRS)在睡眠呼吸暂停综合征(SAS)患者中的表现,探讨SAS患者脑部代谢变化的影响因素。方法纳入打鼾患者93例,行多导睡眠监测仪(PSG)监测并根据睡眠呼吸暂停低通气指数(AHI)将所有对象分为4组:非SAS组(n=27)、轻度SAS组(n=23)、中度SAS组(n=24)和重度SAS组(n=19)。所有入选患者均行海马区MRS检查,收集N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)及乳酸(Lac)的结果。采用单因素方差分析比较4组研究对象脑部MRS的结果,应用多元逐步回归方法分析SAS患者的脑部代谢损害的影响因素。结果中度以上SAS患者NAA下降(轻度0.26±0.05 vs中度0.22±0.04,P<0.05)、Lac(轻度0.02±0.01 vs中度0.13±0.09 vs重度0.22±0.11,P均<0.05)及Lac/Cr升高(轻度0.13±0.11 vs中度0.98±0.66 vs重度1.5±0.76,P均<0.05);NAA/Cr与AHI负相关,偏相关系数为-0.296,AHI是NAA/Cr下降的危险因素(R2=0.077,F=8.056,P=0.006,95%CI为-0.004^-0.001);Lac/Cr与AHI正相关,偏相关系数为0.77,AHI是Lac/Cr升高的危险因素(R2=0.589,F=122.589,P<0.001,95%CI为0.022~0.032)。结论 NAA与Lac在中、重度SAS患者中有明显改变;AHI分别是Lac/Cr升高与NAA/Cr下降的危险因素。

Objective A case-control study was designed to analyze the metabolic changes of the hippocampus in SAS by means of MRS. To evaluate the risk factors that influence the brain metabolites. Methods 93 snoring patients were enlisted and underwent polysomnograghy（ PSG）. All patients were divided into 4 parts according to apnea hypopnea index（ AHI） ： 27 non-SAS,23 mild SAS,24 moderate SAS and 19 severe SAS group. All participants underwent hippocampal MRS. the data of N-acetylaspartate（ NAA）,choline（ Cho）,creative（ Cr） and lactate（ Lac） were collected. The results of hippocampal MRS among 4 groups were compared by One-Way ANOVA analysis. The influence factors of metabolite changes in SAS were explored by multiple stepwise regression analysis. Results NAA decreased in moderate SAS（ 0. 13± 0. 09） compared with mild SAS（ 0. 26 ± 0. 05）（ P〈 0. 05）. Lac and Lac / Cr ratio increased in moderate SAS（ Lac 0. 13± 0. 09,Lac / Cr 0. 95 ± 0. 66） and in severe SAS（ Lac 0. 22 ± 0. 11,Lac / Cr 1. 5 ± 0. 76） compared with mild SAS（ Lac0. 02 ± 0. 01,Lac / Cr 0. 13 ± 0. 11）（ P 〈0. 05）. AHI was negatively correlated with NAA / Cr ratio,the partial correlated coefficient was- 0. 296,AHI was the risk factor of NAA / Cr ratio（ R2= 0. 077,F = 8. 056,P = 0. 006,95% CI- 0. 004 -- 0. 001）; AHI was positively correlated with Lac / Cr ratio,the partial correlated coefficient was 0. 77,AHI was the risk factor of Lac / Cr ratio（ R2= 0. 589,F = 122. 589,P 〈0. 001,95% CI 0. 022 - 0. 032）. Conclusion NAA and Lac ratio was significantly changed in moderate and severe SAS. AHI was the risk factor of Lac / Cr ratio and NAA / Cr ratio separately.