原发性失眠患者脑磁共振波谱成像研究

Study on thecerebrum metabolism in PI patients using magnetic resonance spectroscopy

目的研究原发性失眠(primary insomnia,PI)患者不同脑区(丘脑、海马、壳核)代谢特点。材料与方法采用氢质子磁共振波谱成像技术检测38例PI患者(PI组)和39例健康对照者(healthy control,HC)组丘脑、海马区、壳核区的氮-乙酰基天门冬氨酸(N-acetyl-aspartate,NAA)、胆碱复合物(choline-containing compounds,Cho)和肌酸(creatine,Cr)浓度,并计算NAA/Cr和Cho/Cr。采用多导睡眠监测(polysomnography,PSG)技术监测客观睡眠参数;采用神经心理量表匹茨堡睡眠质量指数和睡眠严重程度指数评定所有受试者的主观睡眠质量和失眠严重程度;采用状态-特质焦虑量表(State-Trait Anxiety Inventory,STAI)和贝克抑郁量表(Beck Depression Inventory,BDI)评定受试者的焦虑及抑郁程度。结果(1)代谢物浓度比较:与HC组对比,PI组左侧丘脑Cr、Cho浓度升高(P=0.040,P=0.007),右侧丘脑Cho浓度升高(P=0.039),双侧海马和壳核区的代谢物与对照组相比差异无统计学意义(Pall>0.05)。(2)相关性:PI患者左侧丘脑NAA值与总睡眠时间、睡眠效率呈负相关(r=-0.384,P=0.017),左侧丘脑NAA/Cr值与REM%呈负相关(r=-0.387,P=0.016);右侧丘脑Cho/Cr值与SL%呈正相关(r=0.380,P=0.019),丘脑NAA、Cr、Cho、NAA/Cr、Cho/Cr值与各量表评分未见明显相关。PI患者左侧海马Cho值与ArI呈正相关(r=0.348,P=0.044);右侧海马Cho值(r=-0.334,P=0.047)、Cr值(r=-0.445,P=0.007)与BDI评分呈负相关。PI患者左侧壳核NAA值与N3%呈正相关(r=0.340,P=0.037);左侧壳核Cr值与特质焦虑量表(Trait Anxiety Inventory,TAI)呈正相关(r=0.447,P=0.005);左侧壳核NAA/Cr值与N1%(r=-0.344,P=0.047)、TAI评分(r=-0.521,P=0.001)、状态焦虑量表(State Anxiety Inventory,SAI)评分(r=-0.400,P=0.013)呈负相关;左侧壳核Cho/Cr与TAI评分(r=-0.527,P=0.001)、SAI评分(r=-0.434,P=0.007)呈负相关。组间差异的参数与各量表评分及PSG参数未见明显的相关性。结论PI患者丘脑Cho及Cr代谢紊乱;客观睡眠影响丘脑区域代谢,而患者情绪障碍与海马和壳核区域的代谢有关。

Objective:To study the cerebrum metabolism in patients with primary insomnia(PI).Materials and Methods:Proton magnetic resonance spectroscopy technology was used to detect concentrations of N-acetyl-aspartate,choline-containing compounds and creatine in the thalamus,hippocampus and putamen of 38 PI patients(PI group)and 39 healthy controls(HC group),and NAA/Cr and Cho/Cr were calculated.Polysomnography(PSG)was used to measure objective sleep parameters.Assess sleep quality by fill in the form of the Pittsburgh sleep quality index and insomnia severity index;Assess sentiment by fill in the form of State-Trait Anxiety Inventory(STAI)and Beck Depression Inventory(BDI).Results:(1)Comparison of metabolite concentration:compared with the HC group,the concentration of Cr and Cho in the left thalamus of PI group increased(P=0.040,P=0.007),the concentration of Cho in the right thalamus increased(P=0.039),bilateral hippocampus and shell The metabolites in the nuclear area were not different from the control group(Pall>0.05).(2)Correlation:The NAA value of the left thalamus in PI patients is negatively correlated with total sleep time and sleep efficiency(r=-0.384,P=0.017),and NAA/Cr value is negatively correlated with REM%(r=-0.387,P=0.016);right thalamus Cho/Cr value is positively correlated with SL%(r=0.380,P=0.019),There was no significant correlation between the thalamus NAA,Cr,Cho,NAA/Cr,Cho/Cr values and the scores of each scale.The Cho value of the left hippocampus of patients with insomnia is positively correlated with ArI(r=0.348,P=0.044);the Cho value of the right hippocampus(r=-0.334,P=0.047),Cr value(r=-0.445,P=0.007)and The BDI score was negatively correlated.The NAA value of the left putamen of PI was positively correlated with N3%(r=0.340,P=0.037);The Cr value of the left putamen is positively correlated with Trait Anxiety Inventory(TAI)(r=0.447,P=0.005);the NAA/Cr value of the left putamen is correlated with N1%(r=-0.344,P=0.047),TAI score(r=-0.521,P=0.001),State Anxiety Inventory(SAI)score(r=-0.400,P=0.013)is negatively correlated;Cho/Cr on the left putamen is negatively correlated with TAI score(r=-0.527,P=0.001)and SAI score(r=-0.434,P=0.007).There was no obvious correlation between the parameters of the differences between the groups and the scores of the various scales and PSG parameters.Conclusion:The metabolism of Cho and Cr in the thalamus of PI patients is impaired.Objective sleep affects the metabolism of the thalamus.The patient’s mood disorder is related to the metabolism of the hippocampus and putamen.