遗忘型及血管性轻度认知障碍患者尿液AD7c-NTP与~1H-MRS的应用研究

Study on the correlation between urinary Alzheimer-associated neuronal thread protein and magnetic resonance spectrum in patients with amnestic and vascular mild cognitive impairment

目的探讨联合尿液阿尔茨海默病相关神经丝蛋白(AD7c-NTP)检测和氢质子磁共振波谱(1H-MRS)技术在遗忘型轻度认知障碍(aMCI)和血管性轻度认知障碍(vMCI)中的应用价值。方法选取遗忘型轻度认知障碍(aMCI组)、血管性轻度认知障碍(vMCI组)各40例,另选取健康对照者40例作为对照组(HC组)。采用简易智能状态量表(MMSE)、剑桥老年认知检查表中国修订版(CAMCOG-C)等多种神经心理学量表对所有受试对象进行认知功能评价;采用酶联免疫吸附法测试三组中尿液AD7c-NTP水平;采用1H-MRS技术,比较aMCI、vMCI以及HC组脑内兴趣区(左侧海马、左侧额叶)的N-乙酰天冬氨酸/肌酸(NAA/Cr)、胆碱/肌酸(Cho/Cr)、肌醇/肌酸(MI/Cr)的差异。结果aMCI组和vMCI组MMSE评分及CAMCOG-C总分及其多个亚分均低于HC组,差异有统计学意义(P<0.05)。aMCI组和vMCI组中尿液AD7c-NTP均高于HC组,差异有统计学意义(均P<0.05),aMCI组AD7c-NTP较vMCI组更高,但差异无统计学意义。MRS结果中,aMCI组左侧海马NAA/Cr比值低于vMCI组及HC组,vMCI组左侧额叶NAA/Cr比值低于aMCI组及HC组,差异有统计学意义(均P<0.05)。在aMCI和vMCI组中,尿液AD7c-NTP与MMSE、CAMCOG-C总分均呈负相关(P<0.05),其中aMCI组尿液AD7c-NTP与近记忆、左侧海马的NAA/CR呈负相关(P<0.05),vMCI组尿液AD7c-NTP与执行、左侧额叶的NAA/CR呈负相关(P<0.05)。结论尿液AD7c-NTP可在一定程度上反映aMCI和vMCI患者的相应脑区代谢变化;联合尿液AD7c-NTP和1H-MRS可能为aMCI及vMCI的早期诊断和鉴别提供更准确的方法。

Objective To explore the application value of urinary Alzheimer-associated neuronal thread protein (AD7c-NTP) level and hydrogen proton magnetic resonance spectroscopy ( 1H-MRS) in patients with aMCI and vMCI. Methods The cognitive function of 40 aMCI patients(aMCI group),40 vMCI patients(vMCI group) and 40 healthy controls(HC group)was evaluated by neuropsychological tests such as the Mini-mental State Examination (MMSE) and Cambridge Cognitive Examination-Chinese version (CAMCOG-C).ELISA was used to test the urine level of AD7c-NTP. 1H-MRS technique was used to compare the differences of n-acetylaspartic acid/creatine (NAA/Cr),choline/creatine (Cho/Cr),inositol/creatine (MI/Cr) among the brain regions of interest(the left hippocampus and left frontal lobe). Results The CAMCOG-C and MMSE scores in AD and aMCI were significantly lower in comparison with that in HC ( P< 0.05).The AD7c-NTP in the aMCI group and vMCI group was significantly higher than that in the control group( P< 0.05),and the AD7c-NTP in the aMCI group was higher than thatin the vMCI group,but no statistical difference.The aMCI group showed that the ratio of NAA/Cr in the left hippocampus was significantly lower than that of the vMCI group and the control group ( P< 0.05).The NAA/Cr ratio in the left frontal lobe of vMCI group was significantly lower than that of aMCI group and control group ( P< 0.05).In the aMCI and vMCI groups,urine AD7c-NTP was negatively correlated with the total score of MMSE,CAMCOG ( P< 0.05).Urine AD7c-NTP in the aMCI group was negatively correlated with near-memory and NAA/CR in the left hippocampus ( P< 0.05),and urine AD7c-NTP in the vMCI group was negatively correlated with praxi and NAA/CR in the left frontal lobe. Conclusion Urine AD7c-NTP can reflect the corresponding brain structure and metabolic activity of aMCI and vMCI patients to a certain extent.Combined urine AD7c-NTP and 1H-MRS may provide a more accurate method for the early diagnosis and identification of aMCI and vMCI.