艾滋病病毒相关神经认知障碍的1H-MRS诊断初探  

A primary study of 1H-MRS in the diagnosis of HIV associated neurocognitive disorders

作　　者：丁茜琳 邓文娟[1] 符丹卉[1] 罗宁斌[1] 赵阳[1] 黄绍标[2] 吴念宁[2] 苏丹柯[1] DING Qianlin;DENG Wenjuan;FU Danhui;LUO Ningbin;ZHAO Yang;HUANG Shaobiao;WU Nianning;SU Danke(Imaging Center,the Affiliated Tumor Hospital of Guangxi Medical University,Nanning 530021,China;Department of Infection,the Fourth People's Hospital of Nanning,Nanning 530000,China)

机构地区：[1]广西医科大学附属肿瘤医院影像诊断中心,广西南宁530021 [2]南宁市第四人民医院感染科,广西南宁530000

出　　处：《实用放射学杂志》2020年第5期689-693,共5页Journal of Practical Radiology

基　　金：广西重点研发计划基金资助项目(桂科AB16380201);广西医科大学青年科学基金资助项目(GXMUYSF201727)。

摘　　要：目的探讨1H-MRS对艾滋病病毒(HIV)相关神经认知障碍(HAND)的临床诊断应用价值.方法使用3.0T MR超导扫描仪对26例HIV感染者及16例正常志愿者进行多体素MRS扫描,测量双侧额叶深部灰质、白质的N-乙酰天门冬氨酸(NAA)、胆碱化合物(Cho)、肌酸(Cr)峰下面积,采用一系列神经心理测评的方法将HIV感染者分为无神经认知损害组(UN组)、无症状-轻度神经认知障碍组(ANI-MND组)及HIV相关痴呆组(HAD组),比较各分组与健康对照组(C组)及各亚组间NAA/Cr与Cho/Cr的差异;另外根据患者CD4+T细胞计数结果,将CD4+T细胞<200/mm3者作为重度免疫缺陷组(A组),CD4+T细胞≥200/mm3者作为非重度免疫缺陷组(B组),比较各分组间NAA/Cr与Cho/Cr的差异.结果ANI-MND组与HAD组左侧额叶白质区NAA/Cr值均低于C组(PANI-MND vs C=0.004、PHAD vs C=0.000);HAD组左侧额叶白质区NAA/Cr值低于UN组(PHAD vs UN=0.010).A组、B组、C组两侧额叶灰、白质的NAA/Cr呈逐渐升高趋势,部分差异有统计学意义(P左侧额叶灰质A vs C=0.006、P左侧额叶白质A vs B=0.026、P左侧额叶白质B vs C=0.025、P左侧额叶白质A vs C=0.000、P右侧额叶白质A vs C=0.036);A组、B组、C组左侧额叶灰、白质的Cho/Cr呈逐渐降低趋势,部分差异有统计学意义(P左侧额叶白质A vs C=0.018).结论HIV感染者额叶MRS代谢产物变化与CD4+T细胞计数存在关系,可为HAND的诊断及其严重程度评估提供量化参考依据.Objective To investigate the diagnostic value of H-MRS in HIV associated neurocognitive disorders(HAND).Methods Twenty-six HIV-infected patients and 16 healthy volunteers were evaluated at 3.0T MR using multi-voxel'H-MRS.The areas under the peaks of NAA,Cho and Cr in the bilateral frontal white matter(FWM)and bilateral frontal gray matter(FGM)were measured.HIV-infected patients were divided into non neurocognitive impairment group(UN group)。asymptomatic neurocognitive impairment mild neurocognitive disorder group(ANI-MND group)and HIV-related dementia group(HAD group)by neuropsychological assessment,and the differences of NAA/Cr and Cho/Cr between these groups and the healthy control group(group C)were compared.According to the CD4+T cell count results,CD4+T cells<200/mm^3 was considered as the severe immunodeficiency group(group A),CD4^+T cells≥200/mm^3 was considered as non-severe immunodeficiency group(group B),and the differences of NAA/Cr and Cho/Cr between groups were compared.Results Compared with group C,the ratios of NAA/Cr at the left FWM were lower in group ANI-MND and HAD than group C(PANIGMNDvsC=0.004,PHADvsC=0.000),and the left FWM NAA/Cr was lower in HAD group compared with UN group(P HAD vs UN=0.010).Bilateral frontal lobe NAA/Cr were gradually increased in group A,B,C(P L-FGM A vs C=0.006,P LFWM A vs B=0.026,P L-FWM B vs C=0.025,P LFWM A vs C=0.000,P R-FWM A vs C=0.036);The left frontal lobe Cho/Cr were gradually decreased in group A,B,C(P LFWM A vs C=0.018).Conclusion MRS metabo lic abnormalities in the frontal lobe of HIV-infected patients is related to CD4^+ T cell count,which can provide a quantitative reference for the diagnosis of HAND.

关 键 词：艾滋病病毒 艾滋病病毒相关神经认知障碍 磁共振波谱 

分 类 号：R742[医药卫生—神经病学与精神病学] R512.91[医药卫生—临床医学]