帕金森病患者脑部非运动功能区磁共振波谱分析

Application study of non-motor functional area in patients with Parkinson disease by magnetic resonance spectroscopy

目的 应用氢质子磁共振波谱分析（1H-MRS）计数检测研究帕金森病（PD）患者脑部非运动功能区代谢物变化.方法 选择PD患者42例（PD组）、健康体检者20例（正常对照组）,进行头颅MRI和1H-MRS检查,测定非运动功能区前额叶、海马区、楔回及背侧丘脑的脑代谢物N-乙酰天冬氨酸（NAA）/肌酸（Cr）、NAA/胆碱化合物（Cho）和Cho/Cr,比较两组代谢物的差异性.结果 PD组NAA/Cr、NAA/Cho在双侧背侧丘脑、楔回、海马区、前额叶均显著低于正常对照组,差异有统计学意义（P＜ 0.01）;PD组Cho/Cr在右背侧丘脑、右侧楔回、右侧海马区均高于正常对照组,差异有统计学意义（P＜0.05）.PD组左海马区（r=-0.388,P=0.011）和左楔回（r=-0.325,P=0.036） NAA/Cho与帕金森综合评分量表（UPDRS）呈负相关.结论 PD患者脑部存在非运动功能区前额叶、海马区、楔回以及背侧丘脑广泛神经元损害,伴有部分胶质增生,左海马区、左楔回脑代谢异常与临床病情严重程度呈正相关.

Objective To detect the metabolites of non-motor functional area in patients with Parkinson disease （PD） by proton magnetic resonance spectroscopy （1H-MRS）.Methods Forty-two PD patients （PD group） tested with unified PD rating scale （UPDRS） and 20 healthy controls（normal control group） were enrolled in this study.MRI and 1H-MRS using a GE signa excite1.5T MR was obtained,and the ratios of metabolites such as N-acetylaspartate（NAA）/creatin（Cr）,NAA/cholinecompounds（Cho） in the prefrontal lobe,hippocampus,cuneus gyrus and dorsal thalamus were compared.Correlations between brain metabolites and UPDRS were analyzed.Results The levels of NAA/Cr,and NAA/Cho in bilateral dorsal thalamus,cuneus gyrus,hippocampus,prefrontal lobe in PD group were significantly lower than those in normal control group （P ＜ 0.01）.The level of Cho/Cr in right hippocampus,right cuneus gyms,and right dorsal thalamus in PD group was significantly higher than that in normal control group （P ＜ 0.05）.The NAA/Cho in the left hippocampus （r =-0.388,P =0.011） and left cuneus gyrus （r =-0.325,P =0.036） was negatively correlated with UPDRS scores （P ＜ 0.05）.Conclusions There is extensive neuronal damage and some glial proliferation in the non-motor functional areas including prefrontal lobe,hippocampus,cuneus gyrus,anddorsal thalamus in the PD patients.The degree of damage in left hippocampus and left cuneus gyms is positively correlated with the severity of the disease clinically.