多发性硬化肝肾阴虚与脾肾阳虚患者的质子共振波谱分析及弥散张量成像研究  

Proton magnetic resonance spectroscopy and diffusion tensor imaging in patients with multiple sclerosis of liver-kidney yin deficiency type or spleen-kidney yang deficiency type

作　　者：尤昱中[1] 樊永平[2] 

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]首都医科大学附属北京天坛医院

出　　处：《北京中医药大学学报》2011年第4期277-281,共5页Journal of Beijing University of Traditional Chinese Medicine

基　　金：首都医学发展科研基金资助项目(No.2005-SF-1)

摘　　要：目的观察多发性硬化肝肾阴虚型与脾肾阳虚型患者的质子共振波谱分析及弥散张量成像差异。方法对45例多发性硬化(MS)急性期患者的临床表现进行辨证分型,分为肝肾阴虚型(28例)及脾肾阳虚型(17例),并比较两型患者之间发病年龄、复发次数、病程长短、扩展伤残等级(EDSS)评分、中医症状评分、磁共振、质子共振波谱分析及弥散张量成像差异。结果两型患者发病年龄、病程长短、复发次数、EDSS评分、中医症状评分、病灶位置、病灶强化反应差异无统计学差异。脾肾阳虚型的氮-乙酰天门冬氨酸/肌酸(NAA/CR)比值趋向低于肝肾阴虚型,表示脾肾阳虚型的轴索损伤趋向明显;肝肾阴虚型胆碱/肌酸(CHO/CR)比值趋向高于脾肾阳虚型,表示肝肾阴虚型的髓鞘脱失趋向明显。脾肾阳虚型的表观弥散系数(ADC)比值趋向高于肝肾阴虚型、各向异性(FA)比值趋向低于肝肾阴虚型,表示脾肾阳虚型白质纤维束损伤趋向明显,两者比值差异无统计学意义。结论多发性硬化肝肾阴虚型与脾肾阳虚型患者之间可能存在质子共振波谱分析及弥散张量成像差异。Objective To observe the difference between proton magnetic resonance spectroscopy（PMRS） and diffusion tensor imaging（DTI） in the patients with multiple sclerosis（MS） of liver-kidney yin deficiency type or spleen-kidney yang deficiency type.Methods The MS patients at acute stage（n=45） were divided into liver-kidney yin deficiency type（n=28） and spleen-kidney yang deficiency type（n=17）.The age when the patients were get attacked for first time,number of recrudescence,duration of disease course,scores of Expanded Disability Status Scale（EDSS）,scores of TCM symptoms,and outcomes of nuclear magnetic resonance（NMR）,PMRS and DTI were compared in two-type patients.Results There was no statistical difference between two type patients in the age,number of recrudescence,duration of disease course,EDSS scores,scores of TCM symptoms,focus location and focus reinforced reaction.The ratio of NAA to CR tended to be lower in spleen-kidney yang deficiency type than that in liver-kidney yin deficiency type,indicating the trends of axonotmesis being significant in spleen-kidney yang deficiency type.The ratio of CHO to CR tended to be higher in liver-kidney yin deficiency type than that in spleen-kidney yang deficiency type,indicating the trends of demyelination being significant in liver-kidney yin deficiency type.The ratio of apparent diffusion coefficient（ADC） tended to be higher and the ratio of fractional anisotropy（FA） tended to lower in spleen-kidney yang deficiency type than those in spleen-kidney yang deficiency type,indicating the trends of lesion of white matter fiber tract being significant in spleen-kidney yang deficiency type.The difference of ratio between two types had no statistical significance.Conclusion There maybe the difference in PMRS and DTI between liver-kidney yin deficiency type and spleen-kidney yang deficiency type in patients with MS.

关 键 词：多发性硬化 中医证型 质子共振波谱分析 弥散张量成像 

分 类 号：R744.51[医药卫生—神经病学与精神病学]