磁共振质子波谱成像在卒中后认知障碍研究中的应用

Clinical significance of proton magnetic resonance spectroscopy in the study of cognitive impairment after stroke

目的:采用磁共振质子波谱成像(1H-MRS)技术,研究卒中后认知障碍(PSCI)患者脑内代谢物质含量的变化及其与认知损害程度的相关性,探讨其临床应用价值。方法:收集80例卒中患者,根据简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MOCA)评分结果分为卒中后认知障碍组(PSCI组)30例,卒中后认知功能正常组(NCI组)50例。收集同期健康体检的志愿者20例作为正常对照组(NOR组)。对各组病例进行1H-MRS检查,计算双侧额叶白质N-乙酰天门冬氨酸盐(NAA)/肌酸(Cr)、胆碱复合物(Cho)/肌酸(Cr)、肌醇(MI)/肌酸(Cr)及肌醇(MI)/N-乙酰天门冬氨酸盐(NAA)的比值,并进行统计分析。结果:PSCI组左侧、右侧的NAA/Cr值显著低于NCI组和NOR组(P<0.05),MI/Cr、MI/NAA值均大于NCI组和NOR组(P<0.05)。PSCI组和NCI组Cho/Cr值比较差异无统计学意义(P>0.05),但两组指标均与NOR组的Cho/Cr值比较,差异具有统计学意义(P<0.05)。PSCI组NAA/Cr值与MMSE、MOCA评分存在正相关性,MI/Cr、MI/NAA值与MMSE、MOCA评分存在负相关性(P<0.05),而Cho/Cr值与MMSE、MOCA评分不存在相关性(P>0.05)。结论:1H-MRS检查可反映PSCI患者脑内代谢物变化,有利于实现疾病早期、无创、准确和全面的评估。

Objective:To study the changes of cerebral metabolites in patients with post-stroke cognitive impairment(PSCI)by proton magnetic resonance spectroscopy(1 H-MRS)and its correlation with the degree of cognitive impairment,and to explore its clinical application value.Methods:80 stroke patients were collected and divided into PSCI group(30 cases)and NCI group(50 cases)according to the results of Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MOCA).20 healthy volunteers who underwent physical examination during the same period were collected as the normal control group(NOR group).Each group was examined by 1 H-MRS,and the ratio of N-acetyl aspartic acid(NAA)/creatine(Cr),choline complex(Cho)/Cr,inositol(MI)/Cr and MI/NAA in bilateral frontal white matter was calculated and analyzed.Results:The NAA/Cr values of the left and right sides in the PSCI group were significantly lower than those in the NCI group and NOR group(P<0.05),and the MI/Cr and MI/NAA values were both higher than those in the NCI group and NOR group(P<0.05).There was no significant difference in Cho/Cr value between the PSCI group and the NCI group(P>0.05),but there was significant difference in Cho/Cr value between the two groups and NOR group(P<0.05).In the PSCI group,NAA/Cr value was positively correlated with MMSE and MOCA scores,MI/Cr and MI/NAA values were negatively correlated with MMSE and MOCA scores(P<0.05),while Cho/Cr value was not correlated with MMSE and MOCA scores(P>0.05).Conclusion:The 1 H-MRS examination can reflect the changes of metabolites in the brain of PSCI patients,which is conducive to the early,non-invasive,accurate and comprehensive evaluation of the disease.