颈脊髓慢性压迫症的代谢组学研究  

Metabolic neuroimaging of the cervical spinal cord in patients with compressive myelopathy:a prospective study on magnetic resonance spectroscopy

作　　者：张琥[1] 林定坤[1] 陈博来[1] 龙玉[1] 田铁桥[1] 陈树良[1] 陈加良[1] 黄思聪[1] 

机构地区：[1]广东省中医院骨科,广州510120

出　　处：《中国骨与关节外科》2010年第6期427-432,共6页Chinese Journal of Bone and Joint Surgery

基　　金：广东省自然科学基金(8451040701001571);广东省医学科研基金(B2008 063)

摘　　要：目的探讨应用磁共振波谱技术(magneticresonance spectroscopy,MRS)测量颈脊髓慢性压迫症患者脊髓代谢组改变的可行性,探讨脊髓代谢组学与脊髓功能的相关性。方法 2009年1月至2010年6月行减压手术的脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者13例作为实验组,男8例,女5例;年龄37～84岁,平均58.2岁。术前进行神经系统检查、神经功能评价(JOA评分)和MRS检查,将感兴趣区放置在脊髓受压最严重部位的相邻节段。通过MRS测得以下代谢物的浓度:氮-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)、肌醇(Ins)、谷氨酰氨(Glx)。15名健康志愿者为正常对照组,年龄和性别与实验组无明显差异,同样用MRS测得脊髓代谢浓度。计算以下代谢浓度的比值:NAA/Cr、Cho/Cr、Lac/Cr、Ins/Cr、Glx/Cr。结果实验组的NAA/Cr和Glx/Cr比正常对照组明显降低(1.18 vs 2.58,P=0.023;0.56 vs 1.25,P=0.008)。实验组的NAA/Cr与脊髓JOA评分呈正相关。但是两组其他代谢物浓度比值如Cho/Cr,mI/Cr,Lac/Cr的差异均无统计学意义。实验组患者中有4例出现乳酸峰,而对照组中无一例出现乳酸峰。结论 MRS可以定量测量颈脊髓的代谢组学改变。慢性颈脊髓压迫症患者的NAA/Cr和Glx/Cr较健康志愿者明显降低,说明神经元和轴突的减少和损伤。NAA/Cr与脊髓功能的相关性,提示有评价脊髓功能的临床价值,但尚需大样本的研究来证实。Objective To examine whether magnetic resonance spectroscopy（MRS） could be used to visualize deterioration of cervical spinal cord function associated with various degrees of compression and to determine its potential usefulness in assessment of compressive myelopathy.Methods Thirteen patients requiring decompressive surgery for myelopathy were enrolled in this study.The patients underwent preoperative neurological examination,nerve functional assessment（JOA score）,and cervical spine MR spectroscopy.Voxels were placed at the spinal cord level adjacent to the maximum compression. Metabolite concentrations,including N-acetylaspartate（NAA）,creatine plus phosphocreatine（Cr）,choline-containing compounds（Cho）,myoinositol（mI）,lactate（Lac）,glutamate and glutamine（Glx） were obtained with MR spectroscopy.Fifteen aged- and gender- matched controls subjects were also scanned.The following metabolite concentration ratios were obtained：NAA/Cr,Cho/Cr,mI/Cr,Lac/Cr,Glx/Cr.Results The CSM patients showed lower ratios of NAA/Cr and Glx/Cr than controls（1.18 vs 2.58,P = 0.023;0.56 vs 1.25,P = 0.008）.The NAA/Cr ratio correlate with the JOA score in the CSM cohort.No difference was found in the ratios of Cho/Cr,mI/Cr,Lac/Cr between the two groups.Lac peak occurred in 4 CSM patients but not in healthy controls.Conclusion MRS provides useful qualitative and quantitative estimates of the cellular biochemistry of the spinal cord.CSM patents have significantly lower ratios of NAA/Cr and Glx/Cr than healthy controls,reflecting axonal and neuronal loss.The NAA/Cr ratio is found to correlate with the disability. The association between these parameters will require continued investigation with a larger cohort.

关 键 词：磁共振波谱 慢性脊髓压迫症 代谢物 脊髓功能 

分 类 号：R681.55[医药卫生—骨科学]