摘要
背景:轻度认知功能损害代表阿尔茨海默病的极早期状态。磁共振波谱分析已经在阿尔茨海默病的早期诊断和鉴别诊断,以及监测病情进展和药物疗效中崭露头角,但应用磁共振波谱技术分析轻度认知功能损害患者脑部生化改变并分析其与认知功能、形态改变关系的报道较少。目的:分析轻度认知功能损害患者海马结构容积、生化改变及其与认知功能改变的关系,评估磁共振波谱在轻度认知功能损害诊断及病情监测中的价值。设计、时间及地点:病例-对照观察,于2006-09/2008-12在徐州医学院附属连云港医院门诊及神经内科病房完成。对象:纳入轻度认知功能损害患者20例,另外选择与其性别、年龄、文化程度匹配的正常认知的老年人20例。方法:以MRI测定左侧海马结构容积前先对每例观察对象行简明智力状态检查及蒙特利尔认知评估量表、日常生活活动量表、临床痴呆量表、修订韦氏记忆量表评定,同时磁共振波谱分析技术测定海马兴趣区N-乙酰天冬氨酸/肌酸、胆碱/肌酸和肌醇/肌酸值,并对轻度认知功能损害组N-乙酰天冬氨酸/肌酸、胆碱/肌酸、肌醇/肌酸、海马结构体积与认知功能评定得分行相关性分析。主要观察指标:观察对象的海马结构容积,海马区N-乙酰天冬氨酸/肌酸、胆碱/肌酸、肌醇/肌酸值。结果:与正常老年认知组相比,轻度认知功能损害组N-乙酰天冬氨酸/肌酸值降低(P<0.01),肌醇/肌酸值增高(P<0.01),海马结构体积减小(P<0.05)。2组胆碱/肌酸值相比差异无显著性意义(P>0.05)。轻度认知功能损害组患者中,N-乙酰天冬氨酸/肌酸值与蒙特利尔认知评估量表、记忆商数值及左侧海马结构体积有显著相关性(P<0.01);胆碱/肌酸值与记忆商数值有显著相关性(P<0.05);肌醇/肌酸值与蒙特利尔认知评估量表评分值及左侧海马结构体积呈显著负相关(P<0.01),肌醇/肌酸值与记忆商数值呈显著正相关(P<0.01),左侧海马结构体积与蒙特利尔认知评估量表评分、记忆商数值亦呈显著相关性(P<0.01)。结论:轻度认知功能损害患者存在海马容积减小、N-乙酰天冬氨酸/肌酸比值降低与肌醇/肌酸比值升高,其N-乙酰天冬氨酸/肌酸、胆碱/肌酸、肌醇/肌酸、海马结构体积与蒙特利尔认知评估量表评分、记忆商数存在显著相关性。磁共振波谱是轻度认知功能损害诊断和病情监测的有效工具。
BACKGROUND： Mild cognitive impairment （MCI） represents early status of Alzheimer＇s disease. Magnetic resonance spectroscopy （MRS） has been used in early diagnosis and identification as well as monitoring of Alzheimer＇s disease. However, little data is available concerning relationship between cognitive impairment and changes of biochemical metabolites. OBJECTIVE： To investigate the relationship between cognitive impairment and changes of biochemical metabolites as well as volumes of hippocampal formation （HPF） in MCI patients, accordingly to evaluate the roles of MRS in the diagnosis and the state monitoring of MCI. DESIGN, TIME AND SETTING： Case-contrast observation. The study was performed at the Outpatient Department and ward of Department of Neurology, Lianyungang Hospital of Xuzhou Medical College between September 2006 and December 2008. PARTICIPANTS： A total of 20 MCI patients were selected and 20 elderly with normal cognition, matched in gender, age and education, were selected. METHODS： Before volumes of the left HPF were measured by MRS, mini-mentalstate examination （MMSE）, the Montreal Cognitive Assessment （MoCA）, activities of daily living （ADL）, clinical dementia rating （CDR） and Wechsler memory scale （WMS） were used to examine each participant. In addition, the N-acetylaspartate （NAA）/creatine （Cr）, choline （Cho）/Cr, myo-inositol （ml）/Cr of HPF were obtained. Moreover, the correlations between the NAA/Cr, Cho/Cr, ml/Cr and the volume of HPF in MCI group were analyzed. MAIN OUTCOME MEASURES： Volume of HPF, NAA/Cr, Cho/Cr, and ml/Cr. RESULTS： Compared with control group, reduced NAA/Cr （P 〈 0.01 ）, increased ml/Cr （P 〈 0.01） and reduced volume of HPF （P 〈 0.05） were found in the MCI subjects. No significant difference was observed in the Cho/Cr between two groups （P 〉 0.05）. In the MCI group, the NAA/Cr remarkably correlated with MoCA, memory quotient, and volumes of left HPF （P 〈 0.01 ）; Cho/Cr significantly correlated with memory quotient （P 〈 0.05）; ml/Cr has remarkably negative correlation with MoCA and volumes of left HPF （P 〈 0.01 ）, but positive correlation with memory quotient （P 〈 0.01 ）. The volumes of left HPF also remarkably correlated with MoCA and memory quotient （P 〈 0.01 ）. CONCLUSION： An increased ml/Cr ratio, a decreased left HPF volumes and NAA/Cr ratio were observed in the MCI patients. Significant correlations between biochemical metabolites of HPF, HPF volumes and MoCA as well as memory quotient were observed. MRS plays an important role in the diagnosis and state monitoring of MCl.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第26期5098-5103,共6页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
连云港市卫生局资助项目(06007)
江苏省"六大人才高峰"项目资助课题(07-B-009)~~
