驱铜治疗对肝豆状核变性患者脑组织磁共振波谱的影响  

Brain1H-MRS study on the effects of copper chelation therapy on WD patients

作　　者：吴舒梅[1] 胡文彬[2] 韩咏竹[2] 胡纪源[2] 王训[2] 李凯 王共强[2] 吴君霞[2] 苏增锋 杨任民[2] 

机构地区：[1]合肥市第八人民医院神经内科,合肥238000 [2]安徽中医药大学神经病学研究所附属医院 [3]合肥市滨湖医院干部病房神经内科

出　　处：《中国神经精神疾病杂志》2015年第10期601-606,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金资助项目(编号:81473535)

摘　　要：目的观察肝豆状核变性(wilson disease,WD)患者脑组织氢质子磁共振波谱(1H-MRS)的改变及患者在驱铜治疗前后脑组织1H-MRS的变化情况,为WD的评价预后提供参考。方法选择39例WD患者,分为非脑型组18例;脑型疗前组及短期治疗组均为21例,其中长期治疗组20例。分别利用1.5T超导磁共振诊断仪对患者进行1H-MRS单体素信号采集,在驱铜治疗后再次检测,比较治疗前后各指标的变化。20例均无血缘关系的健康志愿者作为对照组。结果患者的年龄、性别与对照组有可比性。39例WD患者左侧壳核、尾状核头部NAA/Cr较丘脑部位明显降低(P<0.01)。非脑型组左侧壳核部位、丘脑部位NAA/Cr及Cho/Cr的均值较对照组明显降低(P<0.01)。脑型疗前组左侧壳核、尾状核头及丘脑部位NAA/Cr、Cho/Cr及NAA/Cho的均值较对照组明显降低(P<0.01或P<0.05)。短期治疗组左侧壳核、尾状核头及丘脑部位NAA/Cr、Cho/Cr及NAA/Cho的均值较脑型疗前组无统计学差异(P>0.05);长期治疗组左侧壳核、丘脑部位NAA/Cr及NAA/Cho的均值较脑型疗前组明显升高(P<0.01或P<0.05),尾状核头Cho/Cr的均值与脑型疗前组比较明显升高(P<0.05)。患者左侧壳核、尾状核头及丘脑NAA/Cr的均值与病程呈负相关(P<0.05)。结论不同类型的WD患者之间的1H-MRS表现也存在着差异,短期驱铜治疗对WD患者1H-MRS的影响不明显,而长期、正规的综合驱铜治疗能使WD患者的脑代谢得到显著改善。NAA/Cr比值可能作为观察疗效的可逆性非侵袭性指标。Objective To examine the brain metabolic changes in WD patients receiving copper chelation by us- ing 1H-MRS. Method Thirty-nine patients with WD was randomly divided into four groups： non-brain type group （18 cases）, brain type prior-treatment group and short-term treatment group （21 cases）, long-term treatment group （20 cases） from short-term treatment group, and 20 heahhy volunteers served as a control group. 1H-MRS and MRI were performed on patients on 1.5/MR/MRS system to detect these above-mentioned items before and after treatment. Result The mean of NAA/Cr was significantly lower in the left putamen and head of the caudate nucleus than in the left basal ganglion in the 39 patients with WD. The mean of NAA/Cr and Cho/Cr in the left putamen and basal ganglion was significantly lower in non-brain type group than in control group （P〈0.01）. The mean of NAA/Cr Cho/Cr and NAA/Cho in the left putamen,head of the caudate nucleus and basal ganglion were significantly lower in brain type group than in control group（P〈0.01 or P〈0.05）. The mean of NAA/Cr in the left putamen was much lower in brain type group than in non-brain type group （P〈0.01）. The mean of NAA/Cr, Cho/Cr and NAA/Cho of short-term treatment group in the left putamen, head of the caudate nucleus and basal ganglion was not significantly different between brain type group and short-term treatment group （P〉0.05）. The mean of NAA/Cr and NAA/Cho in the left putamen and basal ganglion was much higher in long-term treatment group than in brain type group （P〈0.01 or P〈0.05 ）. The mean of Cho/Cr in the left head of caudate nucleus were much higher after treatment compared with prior-treatment group （P〈0.05）. The mean of NAA/Cr in the left putamen, head of the left caudate nucleus and basal ganglion in all groups was negatively correlated with course of the disease. Coneluslon There are significant differences in brain metabolism among different type of WD. The long-term but not short-term copper chelation s

关 键 词：肝豆状核变性 磁共振波谱 驱铜治疗 

分 类 号：R742.4[医药卫生—神经病学与精神病学]