质子磁共振波谱在肌萎缩侧索硬化的诊断及其用力如太治疗中应用探讨

Preliminary Study of 1H-MRS in Diagnosis and Treatment with Rilutek in Amyotrophic Lateral Sclerosis Patients

目的:探讨1H-MRS在ALS患者的临床应用价值.方法:对34例ALS病人双侧大脑中央前回进行质子波谱分析,同时进行临床量表评分,并随访其中进行治疗的24例病例.治疗组分两组:力如太组(力如太50mg bid)和免疫治疗组(环磷酰胺和地塞米松).结果:①NAA/Cr比值在ALS病人上显著降低,P＜0.0l;②力如太治疗最初的1个月,NAA/Cr比值上升,P＜0.05,而免疫治疗组(环磷酰胺+地塞米松)无此变化;③NAA/Cr的改善与力如太组在Appel延髓评分的改善相一致,且NAA/Cr比值更为敏感.结论:1H-MRS中的NAA/Cr比值可以作为大脑中央前回运动神经元受损的指标,并且也可用来客观地监测疾病的进展,观察药效.

Aim:To have a preliminary evaluation of1H-MRS application in ALS patients.Methods: Our study focused upon the precentral gyrus to determine whether any signal changes could be detected in ALS patients ( n = 34), and to determine whether any intervention could reverse corticomotoneuron damage in patients with ALS ( n = 24) . All the patients had the clinical ALS scales evaluation as well. We divided the population into two groups: treated patients in the first group with rilutek (rilutek 50 mg bid), patients in the second group receiving immune therapy (cyclophosphamidum combined with dexamethasone). Results: (1) ALS patients have significantly reduced NAA resonance intensity relative to Cr (P<0.01). (2) After one month of therapy, this parameter (NAA/Cr) significantly increased (P<0.05) in the rilutek-treated patients, but remained unchanged in the immune therapy group. (3) The improvement of NAA/Cr was consistent with improvement of bulbar score (Appel Scale) in the rilutek group. The foregoing NAA/Cr appeared to be more sensitive than ALS scale with respect to detection of drug effects. Conclusion: NAA/ Cr could be used as a surrogate corticomotoneuron marker. Furthermore, it could also be used to monitor disease progression or to assess responses to drug therapy.