慢性脑供血不足患者认知功能障碍的磁共振波谱研究  

Magnetic resonance spectroscopy of cognitive impairment in chronic cerebral circulation insufficiency patients

作　　者：戴京红 张颖 苏增锋 王书 Dai Jinghong;Zhang Ying;Su Zengfeng;Wang Shu(Department of Geriatrics,Third Affiliated Hospital of Anhui Medical University,Hefei First People's Hospital,Hefei 230061,Anhui Province,China)

机构地区：[1]安徽医科大学第三附属医院,合肥市第一人民医院老年病科,合肥230061

出　　处：《中华老年心脑血管病杂志》2021年第2期136-139,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：合肥市卫计委2018年应用医学研究重点项目(hwk2018zd011)。

摘　　要：目的采用磁共振波谱(magnetic resonance spectroscopy,MRS)技术检测慢性脑供血不足(CCCI)患者脑内物质代谢的变化。方法选择我院住院确诊的CCCI患者45例,根据简易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分将患者分为单纯CCCI组29例和认知障碍组16例。另选健康志愿者21例作为对照组。入选者行MRS检查,获得优势侧额叶、颞叶、半卵圆中心为感兴趣区(ROI)的N-乙酰天门冬氨酸(NAA)、肌酸和胆碱峰的波幅下面积,计算NAA/肌酸、NAA/胆碱和胆碱/肌酸比值,采用Pearson相关性分析。结果认知障碍组MMSE、MoCA评分明显低于单纯CCCI组和对照组(P<0.05)。认知障碍组在额叶、颞叶、半卵圆中心ROI的NAA/肌酸比值、NAA/胆碱比值均低于单纯CCCI组和对照组(P<0.05);单纯CCCI组与对照组上述指标无显著差异;3组额叶、颞叶、半卵圆中心ROI的胆碱/肌酸比值比较,无统计学差异(P>0.05)。MMSE、MoCA评分与额叶、颞叶、半卵圆中心NAA/肌酸比值(r=0.812和0.657、0.636和0.620、0.482和0.308)、NAA/胆碱比值(r=0.575和0.479、0.565和0.594、0.602和0.404)呈正相关(P<0.05,P<0.01)。结论CCCI认知功能障碍患者认知功能评分与其物质代谢异常具有相关性,对早期诊断CCCI继发认知功能障碍及指导临床治疗具有一定的指导意义。Objective To detect the changes in metabolism of intracerebral substances in chronic cerebral circulation insufficiency(CCCI)patients by magnetic resonance spectroscopy(MRS).Methods Forty-five chronic cerebral circulation insufficiency patients admitted to our hospital were divided into simple CCCI group(n=29)and cognitive impairment group(n=16)according to their MMSE Scale score and MoCA Scale score.Another 21 healthy volunteers were selected as the control group.The area under the peak wave amplitude of N-acetylaspartic acid(NAA),creatine and choline in ROI of frontal lobe,temporal lobe and half oval center was measured by MRS.The NAA/creatine,NAA/choline and choline/creatine ratios were calculated and analyzed by Pearson correlation analysis.Results The MMSE Scale score and MoCA Scale score were significantly lower in cognitive impairment group than in simple CCCI group and control group(P<0.05).The NAA/creatine and NAA/choline ratios in ROI of frontal lobe,temporal lobe and half oval center were significantly lower in cognitive impairment group than in simple CCCI group and control group(P<0.05).There was no significant difference between CCCI group and control group.There was no statistical difference in choline/creatine ratio among the three groups in ROI of frontal lobe,temporal lobe and half oval center(P>0.05).The MMSE Scale score and MoCA Scale score were positively related with the NAA/creatine(r=0.812,0.657;0.636,0.620;0.482,0.308)and NAA/choline(r=0.575,0.479;0.565,0.594;0.602,0.404)ratios in ROI of frontal lobe,temporal lobe and half oval center(P<0.05,P<0.01).Conclusion The cognitive function score of CCCI patients with cognitive impairment is related with the abnormal metabolism of their intracerebral substances and plays a certain role in early diagnosis and treatment of cognitive impairment secondary to CCCI.

关 键 词：椎底动脉供血不足 认知功能障碍 脑缺血 磁共振波谱学 胆碱 肌酸 早期诊断 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]