盐酸多奈哌齐干预血管性痴呆患者后的磁共振波谱分析  

Clinical efficacy of donepezil in treatment of vascular dementia： study of ^1H-magnetic resonance spectroscopy

作　　者：李瑾[1] 徐融[1] 何迎春[1] 

机构地区：[1]杭州市中医院老年科,310007

出　　处：《中华老年医学杂志》2011年第10期812-815,共4页Chinese Journal of Geriatrics

基　　金：浙江省医药卫生科学研究基金资助项目（2006A102）.

摘　　要：目的利用氢质子磁共振波谱分析（^1H—magnetic resonance spectroscopy，^1H—MRS）技术研究脑卒中后血管性痴呆（vascular dementia，VD）患者颞叶海马区细胞代谢水平及给予盐酸多奈哌齐后，细胞代谢水平的改变及其与临床症状的关系。方法脑卒中VD组18例，男性16例，女性2例，平均年龄（76．9±2．7）岁，符合痴呆的《神经病诊断和统计手册》第4版（DSM-Ⅳ）诊断标准；脑卒中非VD组13例，男性11例，女性2例，平均年龄（76．2±3．6）岁；正常对照组来源于门诊就诊者，共14例，男性12例，女性2例，平均年龄（75．1±2．4）岁。所有人组者均行简易精神状态量表（MMSE）、日常生活活动能力量表（ADL）、汉密尔顿抑郁量表（HAMD）评分以及^1H—MRS检测患者双侧颞叶海马区细胞代谢水平。脑卒中VD组在盐酸多奈哌齐治疗6个月后复查MMSE评分及’H—MRS检查。结果脑卒中VD组患者双侧颞叶海马区N-乙酰天门冬氨酸盐（NAA）／肌酸（Cr）比值较正常对照组及脑卒中非VD组均有显著下降（F=4．23、4．98，均P〈0．05）；而双侧胆碱复合物（Cho）／Cr比值较正常对照组显著升高（P=0．005、0．010），较脑卒中非VD组左侧有显著升高（P=0．038），但右侧差异无统计学意义（P=0．066）。脑卒中非VD组NAA／Cr比值及Cho／Cr比值较正常对照组虽有变化，但差异无统计学意义。脑卒中VD组MMSE评分与双侧颞叶海马区NAA／Cr及Cho／Cr比值有相关性，且MMSE分数越低，NAA／Cr比值越低，而Cho／Cr比值则越高。应用盐酸多奈哌齐干预治疗脑卒中VD组患者6个月后，患者MMSE及ADI。评分均有显著提高（均P〈0．05）；双侧颞叶海马区NAA／Cr比值无明显改善（t=-2．02、-2．04，均P〉0．05），而双侧颞叶海马区Cho／Cr比值有显著下降（t=2．86、2．23，均P〈0．05）。结论^1H—MRS技术可能有助于早发现脑卒中后�Objective To study the cell metabolism changes of hippocampal region in patients with vascular dementia （VD） after stroke by ^1 H-magnetic resonance spectroscopy （^1 H-MRS）, and to observe the relationship between cell metabolism changes and clinical symptoms after donepezil hydrochloride treatment. Methods Enrolled 18 patients with VD after stroke, 16 males and 2 females, with a mean age of （76.9±2.7） years, 13 patients without VD after stroke,11 males and 2 females, with a mean age of （76.2±3.6） years and 14 health volunteers as control group, 12 males and 2 females, with a mean age of （75.1 ±2.4） years. The mini-mental state examination （MMSE）, activities of daily living （ADL） and Hamilton depression scale （HAMD） were used to assess the effects on cognitive function, ability of daily living and behavior symptoms. ^1H-MRS examination of bilateral hippocampus was conducted in all subjects. Metabolisms of N-acetylaspartate （NAA）, choline （Cho） and creatine （Cr） were examined and the ratios of NAA/Cr and Cho/Cr were calculated. The patients with VD were prescribed donepezil and given ^1 H-MRS assessment half a year later. Results The patients with VD had a significantly lower NAA/Cr ratio in bilateral temporal hippocampus area than did health controls and the patients without VD （F=4.23, 4.98, both P〈 0.05）, and a higher Cho/Cr ratio than did health controls and the patients without VD in left hippocampus （P〈0.05）. The NAA/Cr and Cho/Cr ratios in patients without VD had no significant changes compared to health controls. There was a positive relationship between MMSE score and NAA/Cr ratio, and negative relationship between MMSE score and Cho/Cr ratio in the bilateral hippocampus area in patients with VD. After 6 months of treatment of donepezil hydrochloride, the MMSE and ADL scales significantly increased （both P〈0.05）, and NAA/Cr ratio had no significant change in hippocampal region （t= - 2.02, - 2.04, both P〉0.05）, whereas Cho/Cr had signif

关 键 词：卒中 痴呆 血管性 磁共振波谱学 海马 

分 类 号：R445.2[医药卫生—影像医学与核医学]