血管性认知功能障碍和海马氢质子磁共振波谱分析  

Analysis of Vascular Cognitive Impairment and Hippocampal Proton Magnetic Resonance Spectroscopy

作　　者：白亮 黄赛娥 陈雨 林高城 邹愉龙 郑美 BAI Liang;HUANG Saie;CHEN Yu

机构地区：[1]福建中医药大学附属康复医院,福建福州350003 [2]福建省康复技术重点实验室

出　　处：《中国医学创新》2019年第18期6-10,共5页Medical Innovation of China

基　　金：福建省卫生厅青年基金项目(2014-1-71);福建省科技厅科技平台建设项目(2015Y2001)

摘　　要：目的:研究无海马萎缩的血管性痴呆(VD)患者的认知水平和氢质子磁共振波谱(1H-MRS)的关系,探讨其对VD的诊断和评估价值。方法:VD组21例,非VD组19例,对照组10例,采用简易精神状态量表(MMSE)及蒙特利尔认知评估量表(MoCA)进行神经心理学评分;利用1H-MRS技术分析双侧海马N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌酸及磷酸肌酸(Cr)及NAA/(Cr+Cho)的比值;分析各组间认知评分及代谢物的差别,并进行相关性分析。结果:VD组MMSE、MoCA量表评分均低于非VD组和对照组,差异均有统计学意义(P<0.05);VD组双侧海马NAA值均低于非VD组和对照组(P<0.05)。三组Cr、CHo值比较,差异均无统计学意义(P>0.05)。VD组双侧海马NAA/(Cr+Cho)值低于非VD组和对照组(P<0.05)。VD组的MMSE、MoCA量表评分与海马的NAA值正相关,左侧海马(r=0.86、0.78,P<0.05),右侧海马(r=0.81、0.75,P<0.05)。VD组MMSE、MoCA量表评分与海马Cr和Cho值均无相关性(P>0.05)。VD组MMSE、MoCA量表评分与海马NAA/(Cr+Cho)值正相关,左侧海马(r=0.75、0.76,P<0.05),右侧海马(r=0.66、0.67,P<0.05)。结论:无海马萎缩的VD患者存在海马代谢异常,表现为NAA及NAA/(Cr+Cho)值的降低,并且与认知水平呈相关性,1H-MRS技术结合神经心理学量表可对VD患者的评估和诊断提供依据。Objective:To analyze the relationship between cognitive level and proton magnetic resonance spectroscopy(1 H-MRS)in vascular dementia(VD)patients without hippocampal atrophy,and to explore its diagnostic and evaluation value in VD.Method:VD group(n=21),non-VD group(n=19)and the control group(n=10)were evaluated by mini-mental state scale(MMSE)and Montreal cognitive assessment scale(MoCA).The ratios of N-acetylaspartate(NAA),choline complex(Cho),creatine and creatine phosphate(Cr)and NAA/(Cr+Cho)in bilateral hippocampus were analyzed by 1 H-MRS.The differences of cognitive score and metabolites among three groups were analyzed,and the correlation analysis was carried out.Result:The scores of MMSE and MoCA in VD group were significantly lower than those in non-VD group and control group(P<0.05).The NAA values of bilateral hippocampus in VD group were lower than those in non-VD group and control group(P<0.05).There were no significant differences in Cr and Cho among three groups(P>0.05).The value of NAA/(Cr+Cho)in bilateral hippocampus in VD group were lower than those in non-VD group and control group(P<0.05).The scores of MMSE and MoCA in VD group were positively correlated with NAA values in hippocampus,left hippocampus(r=0.86,0.78,P<0.05)and right hippocampus(r=0.81,0.75,P<0.05).There were no correlations between the scores of MMSE and MoCA and the values of Cr and Cho in hippocampus in VD group(P>0.05).The scores of MMSE and MoCA in VD group were positively correlated with NAA/(Cr+Cho)in hippocampus,left hippocampus(r=0.75,0.76,P<0.05)and right hippocampus(r=0.66,0.67,P<0.05).Conclusion:Patients with VD without hippocampal atrophy have abnormal hippocampal metabolism,which is characterized by the decrease of NAA and NAA/(Cr+Cho),and is correlated with cognitive level.1 H-MRS combined with neuropsychological scale can provide the basis for the evaluation and diagnosis of VD patients.

关 键 词：认知障碍 氢质子磁共振波谱分析 血管性痴呆 神经心理学检测 

分 类 号：R749.13[医药卫生—神经病学与精神病学]