慢性失眠症患者认知功能与背外侧前额叶皮质代谢物磁共振波谱研究

Cognitive function and MR spectroscopy of dorsolateral prefrontal cortex in patients with chronic insomnia

目的探讨慢性失眠症(chronic insomnia disorder,CID)患者的认知功能损害特征及背外侧前额叶皮质(dorsolateral prefrontal cortex,DLPFC)代谢物浓度水平,并分析其相关性。方法根据蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)评分将CID分为伴有轻度认知损害组(CID-MCI)27例、无认知损害组(CID-NI)29例,另入组健康对照(HC)30名。行常规MR及多体素磁共振波谱(proton magnetic resonance spectroscopy,^(1)H-MRS)扫描,分析三组DLPFC的N-乙酰天冬氨酸(N-acetylaspartate,NAA)、含胆碱化合物(choline-containing compounds,Cho)、肌醇(myo-inositol,MI)、谷氨酰胺+谷氨酸(glutamine+glutamate,Glx)和肌酸复合物(total creatine,tCr)绝对浓度。结果3组研究对象MoCA评分有统计学差异(P<0.01),其中CID-MCI组较CID-NI组和HC组低(P<0.05)。左侧DLPFC中,CID-MCI组Cho、MI浓度高于CID-NI组和HC组(P<0.05),CID-NI组Cho、MI浓度较HC组升高(P<0.05)。右侧DLPFC中,CID-MCI组Cho、MI浓度高于CID-NI组和HC组(P<0.05)。CID患者中,左侧DLPFC区Cho浓度与MoCA评分呈负相关(r=-0.35,P=0.01),右侧DLPFC区Cho浓度与MoCA评分呈负相关(r=-0.33,P=0.02)。结论部分CID患者MoCA评分降低,CID-MCI患者双侧DLPFC区Cho和MI浓度增加,MoCA评分与双侧DLPFC区Cho浓度水平存在负相关。

Objective To investigate the characteristics of cognitive impairment and the concentration of metabo-lites in dorsolateral prefr ontal cortex(DLPFC)in patients with chronic insomnia(CID).Methods According to the Montreal Cognitive Assessment Scale(MoCA)score,CID patients were divided into two groups:mild cognitive impairment group(CID-MCI,n=27)and non cognitive impairment group(CID-NI,n=29).Another 30 healthy controls(HC)were enrolled.Routine MRI and multivoxel magnetic resonance spectrum(^(1)H-MRS)scanning were performed.LCModel and SAGE software were used to quantitatively analyze the absolute concentration of N-acetylaspartate(NAA),cholinecontaining compounds(Cho),myo-inositol(MI),glutamine+glutamate(Glx)and creatine complex(total creatine,tCr)in DLPFC.Results The MOCA scores of the three groups were significantly different(P<0.05).The MOCA scores were lower in the CID-MCI group than in the CID-NI group and the HC group(P<0.05).In the left DLPFC,the concentrations of Cho and MI were higher in CID-MCI group than in CID-NI group and HC group(P<0.05),and the concentration of Cho and MI was higher in CID-NI group than in HC group(P<0.05).In the right DLPFC,the concentrations were higher in Cho and MI in CID-MCI group than in CID-NI group and HC group(P<0.05).In CID patients,Cho concentration in left DLPFC area was negatively correlated with MOCA score(r=-0.35,P=0.01),Cho concentration in right DLPFC was negatively correlated with MOCA score(r=-0.33,P=0.02).Conclusion MOCA score is decreased in CID patients and the concentrations of Cho and MI in bilateral DLPFC are increased in patients with CID-MCI.MOCA score is negatively correlated with the concentrations of Cho in bilateral DLPFC.