绝经后妇女长期低剂量激素替代疗法的研究——Ⅳ.脑代谢产物的磁共振波谱分析  

The study of long-term low dose sex-hormone replacement therapy in postmenopausal women:Ⅳ. Examination of brain metabolites with MRS

作　　者：左萍萍[1] 胡凌[2] 岳赟[1] 刘雁勇[1] 董毅龙[1] 杨楠[1] 葛秦生[2] 

机构地区：[1]中国医学科学院基础医学研究所北京协和医学院药理室,北京100005 [2]北京协和医学院北京协和医院,北京100730

出　　处：《生殖医学杂志》2009年第4期333-337,共5页Journal of Reproductive Medicine

基　　金：科技部1999年度攀登特别支持费资助项目(国科基字[1999]045)

摘　　要：目的应用质子磁共振波谱(MRS)观察长期低剂量激素替代疗法(HRT)对绝经后妇女脑组织代谢产物的影响,并与载脂蛋白E不同基因型(ApoEε3和ε4)携带者进行比较分析。方法筛选北京协和医院151例绝经后健康女职工纳入了本研究,其中68例采用了小剂量HRT(4～33年,平均11.7年),为HRT组。对照组83例为未经HRT的本院志愿者。所有研究对象采用聚合酶链反应限制性内切酶多型性(PCR-RFLP)方法测定ApoE基因分型,并采用3.0T VH3扫描仪行脑部MRS分析,以谱线下积分面积计算脑代谢产物N-乙酰天门冬氨酸(NAA)、胆碱化合物(Cho)、肌醇(mI)和肌酸(Cr)。结果 NAA主要存在于神经元及其轴索。在ApoEε3基因者中,HRT组和对照组灰质、白质和海马的代谢产物无明显差异,但在ApoEε4基因携带者中,NAA/Cr比值HRT组为(1.54±0.08),对照组为(1.45±0.13),呈显著性差异(P<0.05)。结论 HRT对与认知相关的脑海马神经元有保护作用,特别对携带阿尔兹海默病(AD)的易感基因携带者具有重要意义。Objectives： To i metabolites in the br comparative analysis nvestigate the effect of long-term low ain of postmenopausal women by proto was performed between two ApoE gen dose sex hormone replacement therapy on the n magnetic resonance spectroscopy（MRS） and etype carriers （ApoEε3 and ε4）. Methods： 151 menopausal healthy women from Peking Union Medical College Hospital were enrolled in present study. 68 subjects who had used a low dose of HRT for 4 to 33 years （mean 11.7 years） were selected as HRT group and the other 83 subjects without HRT were enrolled as the control group. The ApoE genetype of all the subjects were analyzed by PCR-RFLP method. The levels of N-Acetyl-aspartic acid （NAA）, choline（Cho）, myo-inositol （mI）, creatine （Cr） were calculated by the method of integral area under proton magnetic resonance spectral curve, which were obtained on 3.0 T VH3 scanner. Results： NAA mainly localized in neuron and its axons. With regard to metabolite levels in the gray matter, white matter and hippocampus, there was not a significant difference between ApoE ε3 carriers in two groups. However, there was a significant difference in the NAA/Cr ratio between the ApoEε4 carriers in two groups （the NAA/Cr ratio of HRT and control group was （1. 54±0.08） and （1. 45±0. 13）, respectively） （P〈0.05）. Conclusions. These findings suggest that the long-term low dose HRT plays a protective role to hippocampal neuron which is related with the cognitive function and is especially helpful to the Alzheimer＇s dis ease （AD） predisposing gene carrier.

关 键 词：绝经后妇女 激素替代疗法 APOE基因型 海马神经元 磁共振波谱 

分 类 号：R459.1[医药卫生—治疗学] R681[医药卫生—临床医学]