慢性颈脊髓压迫的磁共振质谱成像  

Magnetic resonance spectroscopy study of the chronic compression of cervical spinal cord

作　　者：张琥[1] 杜炎鑫[1] 林定坤[1] 陈博来[1] 田铁桥[2] 陈树良[2] 陈加良[2] 蔡懿 

机构地区：[1]广东省中医院脊柱专科,广州510120 [2]广东省中医院影像科,广州510120 [3]广东省广州市海珠区第二人民医院外科,510250

出　　处：《广东医学》2011年第14期1831-1834,共4页Guangdong Medical Journal

基　　金：广东省自然科学基金资助项目(编号:8451040701001571);广东省医学科研基金资助项目(编号:B2008063)

摘　　要：目的探讨慢性颈脊髓压迫患者脊髓磁共振质谱(1H-MRS)成像特点及临床意义,筛选颈脊髓慢性压迫下出现临床症状的危险因素。方法将MRI证实为退变性颈脊髓压迫者34例,按照脊髓功能JOA评分分为两组:症状组(Ⅰ组)15例和无症状组(Ⅱ组)19例。选择同时期15例健康志愿者作为对照组(Ⅲ组)。3组分别测量颈髓代谢物氮-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)波峰下面积,计算NAA/Cr、Cho/Cr、Lac/Cr、Ins/Cr、Glx/Cr。结果 MR发现硬膜压迫4例,脊髓压迫30例,17例有脊髓异常信号。MRS检测发现Ⅰ组NAA/Cr和Glx/Cr较Ⅲ组降低,差异有统计学意义(Z=-2.677,P=0.007和Z=-3.011,P=0.003)。Ⅱ组Glx/Cr较Ⅲ组降低,差异有统计学意义(Z=-2.447,P=0.014)。Glx/Cr是脊髓型颈椎病发病的保护因素,(Wald2=3.951,P<0.05,OR=0.23),MRI信号改变是脊髓型颈椎病发病的危险因素,(Wald2=13.561,P<0.001,OR=35.991)。结论 1H MRS可以半定量测量颈髓代谢物变化,从代谢角度反映颈髓慢性压迫损伤病理变化。脊髓型颈椎病颈髓NAA/Cr和Glx/Cr比值下降,NAA/Cr和Glx/Cr比值有评价脊髓神经功能的潜在价值。慢性脊髓压迫患者有乳酸峰出现,说明存在神经细胞缺血缺氧。Glx/Cr是脊髓型颈椎病发病的保护因素,MRI信号改变是脊髓型颈椎病发病的危险因素,脊髓MRI信号改变的患者应该更注意随访和预防脊髓损伤加重。Objective To evaluate the clinical application of magnetic resonance spectroscopy （MRS） in chronic compression of cervical spinal cord, and to study the risk factors of symptomatic myelopathy. Methods Tirty - four patients with MRI -proved compressed cervical spinal cord, were divided into two groups according to JOA scores： symp- tomatic group （ Group Ⅰ , n = 15 ） and presymptomatic group （ Group Ⅱ , n = 19）. Fifteen aged - matched healthy volunteers were enrolled in control group （ Group Ⅲ ）. Preoperative neurological examination, functional assessment, and cervical spine MR spectroscopy were carried out in patients preoperatively. Voxels were placed at the adjacent level to the maxis compressive level. The main metabolite concentration ratios, including N - acetylaspartate/creatine （ NAA/Cr）, choline/creatine （ Cho/Cr）, myoinositol/creatine （ mI/Cr）, lactate/creatine （Lac/Cr） and glutamate/creatine （ Glx/ Cr）, were obtained. Results Total 49 cases succeeded to have MR spectroscopy. Epidural compression, spinal cord compression and abnormal signal were observed in 4, 30 and 17 cases, respectively. When comparing with. those in Group Ⅲ, significant reduction of NAA/Cr and Glx/Cr were revealed in Group I （P 〈0. 01 ） ; so was significant reduction of Glx/Cr in Group Ⅱ （P 〈 0. 05）. Glx/Cr was proved as a protective factor for cervical spondylotic myelopathy （ Wald χ^2 =3.951, P〈0.05, 0R=0.23）, while altered MRI signal was a risk factor （Wald χ^2 = 13.561, P 〈0.001, OR = 35. 991 ）. Condusion MRS provides useful semi - quantitative estimates of the cellular biochemistry of the spinal cord in patients with chronic compression. Reduced ratios of NAA/Cr and Glx/Cr in patients with CSM indicates the axonal and neuronal loss in cervical spinal cord. Seventy percent of the patients with spondylotic cervical cord compression had signifi- cant Lac peaks, which further supports the role of ischemia in the pathophysiology of chronic compression. The NAA/

关 键 词：慢性脊髓压迫 磁共振质谱 代谢 

分 类 号：R744.2[医药卫生—神经病学与精神病学]