海马^1H-MRS对阿尔茨海默病、血管性痴呆及路易体痴呆诊断的应用

The application of hippocampal 1H-MRS on the diagnosis of Alzheimer's disease, vascular dementia and dementia with Lewy bodies

目的 :研究阿尔茨海默病(AD)、血管性痴呆(VD)及路易体痴呆(DLB)患者双侧海马磁共振波谱代谢物浓度变化特点,探讨海马1H-MRS在三者鉴别诊断中的价值,及对AD早期诊断及病情进展中的意义。方法 :采用3.0T磁共振对67例AD、37例VD、12例DLB患者及28例正常组(NC)进行双侧海马行单体素采集,测定并计算N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌醇(m I)与肌酸(Cr)比值。结果 :病例组双侧NAA/Cr值较NC组降低。AD组、VD组双侧海马m I/Cr值较NC组升高,DLB组与NC组间m I/Cr值无统计学差异。重度AD组双侧NAA/Cr值低于轻中度组。结论 :AD,VD,DLB患者海马区域存在代谢物的改变,这有利于三者的鉴别诊断,m I/Cr可视为AD早期诊断的生物学指标,NAA/Cr值有利于监测AD病情进展及判断预后。

Objective To investigate the metabolic characteristics of proton magnetic resonance spectroscopy(1H-MRS) in bilateral hippocampus in patients with Alzheimer’s disease(AD), vascular dementia(VD) and dementia with Lewy bodies(DLB), and the roles in the differential diagnosis. Methods The metabolic ratios of NAA/Cr, m I/Cr and Cho/Cr in bilateral hippocampus were determined by using 1H-MRS in 67 patients with AD, 37 patients with VD, 12 patients with DLB and 28 normal controls. Results Comparing with the control group, the NAA/Cr value of bilateral hippocampus of AD, VD and DLB group significantly decreased. The m I/Cr value of bilateral hippocampus of AD and VD group significantly increased. There was no significant difference between DLB group and normal controls. The NAA/Cr value of bilateral hippocampus of severe AD group were lower than that of the mild- moderate group. Conclusions There are metabolic alteration in bilateral hippocampus of AD, VD, DLB and it is useful for the differential diagnosis of these three diseases. MI/Cr might be considered as a biomarker for the early diagnosis of AD, NAA/Cr value is useful for monitoring the disease progression and prognosis of AD.