脑白质疏松症患者认知功能障碍的磁共振波谱研究  

Correlates of cognitive impairment in patients with leukoaraiosis by magnetic resonance spectroscopy

作　　者：袁俊亮[1] 王双坤[2] 郭晓娟[2] 彭朋[2] 顾华[2] 赵文慧[1] 牛世芹[1] 胡文立[1] 

机构地区：[1]首都医科大学附属北京朝阳医院神经内科,100020 [2]首都医科大学附属北京朝阳医院放射科,100020

出　　处：《中华医学杂志》2012年第5期303-306,共4页National Medical Journal of China

基　　金：北京市卫生系统高层次卫生技术人才培养计划（2009-03-09）

摘　　要：目的 应用磁共振波谱技术（MRS）探讨脑白质疏松症患者的病理改变及其与认知功能障碍的关系.方法 研究对象来源于2010年8月至2010年11月就诊于首都医科大学附属北京朝阳医院神经内科门诊的23例脑白质疏松症患者和23名年龄、性别、受教育程度相匹配的健康老年人（对照组）,进行神经心理测验,采用化学位移成像采集MRS数据,测量LA患者的脑白质损伤区（ WML）、LA患者的表现正常脑白质区（NAWM）以及对照组正常脑白质区的相对代谢浓度NAA/Cho、NAA/Cr、Cho/Cr,比较3组间MRS代谢参数之间的差异,并与认知功能进行相关性分析.结果 LA患者存在明显的认知功能损害,表现为MMSE得分[（24±3）分]低于对照组[（28±1）分,P＜0.05].MRS分析得出LA患者在双侧前额叶白质损伤区的NAA/Cho、NAA/Cr显著低于对照组（1.72±0.20比1.96±0.36,1.67±0.17比1.85±0.21,P＜0.05）.LA患者在NAWM区的NAA/Cho、NAA/Cr高于白质损伤区（1.83±0.24比1.72±0.20,1.78±0.28比1.67±0.17）,低于对照组（1.83±0.24比1.96±0.36,1.78±0.28比1.85±0.21）,但差异均无统计学意义（均P＞0.05）.相关性分析得出,LA患者在脑白质损伤区的NAA/Cr与其MMSE评分存在显著正相关（r=0.47,P＜0.05）.结论 通过MRS技术发现LA患者的主要病理改变为神经元损伤,且这种改变与认知功能密切相关.Objective To explore the pathological changes in patients with leukoaraiosis （LA） by magnetic resonance spectroscopy （MRS） and examine its relationship with cognitive function.Methods Twenty-three LA patients and 23 age and gender-matched healthy subjects were recruited from the Department of Neurology,Beijing Chaoyang Hospital,Capital Medical University between August 2010 and November 2010.All participants underwent the neuropsychological tests.Multi-voxel chemical shift imaging was performed and the regions of interest were positioned in bilateral frontal white matter. The relative metabolite ratios,involving N-acetyl aspartate/choline ratio （NAA/Cho）,N-acetyl aspartate/creatine （NAA/Cr） and choline/creatine （Cho/Cr）,were estimated.The correlation of the MRS data and the performance of cognitive function was analyzed.Results The LA patients were associated with a worse performance of mini mental state examination （MMSE） versus the healthy controls （24 ± 3 vs 28 ± 1,P 〈0.05）.Univariate analysis of the MRS data revealed the ratios of NAA/Cho and NAA/Cr significantly decreased in bilateral frontal white matter lesions in the LA group versus the control group （ 1.72 ± 0.20 vs 1.96-±0.36,1.67 ± 0.17 vs 1.85 ± 0.21,P 〈 0.05 ）.The values of NAA/Cr and NAA/Cho in normal appearing white matter increased versus the LA group （ 1.83 ± 0.24 vs 1.72 ± 0.20,1.78 ± 0.28 vs 1.67 ±0.17 ） and decreased versus the control group （ 1.83 ± 0.24 vs 1.96 ± 0.36,1.78 ± 0.28 vs 1.85 ± 0.21 ）.But no significant differences were found （P 〉 0.05 ）.The ratio of Cho/Cr did not differ among 3 groups （P〉0.05）.The pathological change of NAA/Cr in white matter lesion in LA patients was markedly correlated with the performance of MMSE（r=0.47,P〈0.05）.Conclusion NAA may be a marker of axonal loss/dysfunction in LA patients.And the changes of NAA/Cr have a positive correlation with cognitive impairment.

关 键 词：脑白质疏松症 认知障碍 磁共振波谱分析 

分 类 号：R742.89[医药卫生—神经病学与精神病学]