^(1)H-MR波谱分析急性期抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎额叶代谢物变化  

^(1)H-MR spectroscopy in analysis of frontal lobe metabolism changes of acute anti-N-methyl-D-aspartate receptor(anti-NMDAR)encephalitis

作　　者：冯雪丹[1] 于莎莎 张玉婧 高煜 陈剑华[1] 马红梅[1] 徐建民 FENG Xuedan;YU Shasha;ZHANG Yujing;GAO Yu;CHEN Jianhua;MA Hongmei;XU Jianmin(Department of Neurology,Beijing Fengtai Youanmen Hospital,Beijing 100069,China;Department of Medical Imaging,Beijing Fengtai Youanmen Hospital,Beijing 100069,China)

机构地区：[1]北京丰台右安门医院神经内科,北京100069 [2]北京丰台右安门医院医学影像科,北京100069

出　　处：《中国医学影像技术》2021年第7期974-978,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的采用1H-MR波谱(^(1)H-MRS)观察急性期抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎双侧额叶代谢物变化及其与认知障碍的关系,评估其应用价值。方法采集20例急性期抗NMDAR脑炎患者(脑炎组)和20名健康成年人(对照组)双侧额叶^(1)H-MRS,获得相应MRS及各代谢物N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌醇(mI)、谷氨酸盐复合物(Glx)和肌酸(Cr)的峰下面积,计算NAA/Cr、Cho/Cr、mI/Cr及Glx/Cr比值。记录脑炎组脑脊液抗NMDAR抗体滴度检测结果,以简易精神状态检查量表(MMSE)和蒙特利尔认知评估(MoCA)量表评估2组认知功能,比较组间^(1)H-MRS参数差异,并分析其与抗NMDAR脑炎患者MMSE评分、MoCA评分及与脑脊液抗NMDAR抗体的相关性。结果脑炎组双侧额叶NAA/Cr、Cho/Cr、mI/Cr、Glx/Cr差异均无统计学意义(t=1.03、2.29、-0.73、0.15,P均>0.05)。与对照组相比,脑炎组双侧额叶NAA/Cr下降、Glx/Cr升高(P均<0.05),而双侧额叶Cho/Cr、mI/Cr差异均无统计学意义(P均>0.05)。脑炎组双侧额叶NAA/Cr、Cho/Cr、mI/Cr及Glx/Cr与MMSE评分、MoCA总分和脑脊液抗NMDAR抗体均无明显相关性(P均>0.05)。结论^(1)H-MRS有助于诊断急性期抗NMDAR脑炎及监测病情;抗NMDAR脑炎急性期双侧额叶NAA/Cr降低、Glx/Cr升高,但与认知障碍无明显相关。Objective To observe bilateral frontal lobe metabolism changes of acute anti-N-methyl-D-aspartate receptor(anti-NMDAR)encephalitis with^(1)H-MR spectroscopy(^(1)H-MRS)and the relationships with cognitive impairment,and to evaluate the application value of^(1)H-MRS in treatment of this disease.Methods^(1)H-MRS of bilateral frontal lobes of 20 patients with acute anti-NMDAR encephalitis(encephalitis group)and 20 healthy adults(control group)were collected to obtain the corresponding MRS and subpeak areas of the metabolites N-acetylaspartate(NAA),choline(Cho),myoinositol(mI),glutamine+glumate(Glx)and creatine(Cr)in bilateral frontal cortex.The ratios of NAA/Cr,Cho/Cr,mI/Cr and Glx/Cr were calculated.The results of cerebrospinal fluid anti-NMDAR antibody in encephalitis group were collected.Cognitive functions were assessed using mini-mental state examination(MMSE)and montreal cognitive assessment(MoCA)scales and compared between groups.MRS results were compared between groups,and the relationships with MMSE and MoCA scores and cerebrospinal fluid anti-NMDAR antibody level in encephalitis patients were analyzed.Results There was no significant difference of NAA/Cr,Cho/Cr,mI/Cr and Glx/Cr of bilateral frontal lobes in encephalitis group(t=1.03,2.29,-0.73,0.15,all P>0.05).Compared with those in control group,the ratio of NAA/Cr decreased and Glx/Cr increased in bilateral frontal lobes in encephalitis group(all P<0.05),while there was no significant difference of Cho/Cr nor mI/Cr of bilateral frontal lobes(all P>0.05).No significant correlation of the ratios of NAA/Cr,Cho/Cr,mI/Cr,Glx/Cr,MMSE,MoCA scores nor of cerebrospinal fluid anti-NMDAR antibody levels was found in encephalitis group(all P>0.05).Conclusion^(1)H-MRS was helpful to diagnosing and monitoring the development of acute anti-NMDAR encephalitis.NAA level decreased and Glx level increased in bilateral frontal cortex in acute anti-NMDAR encephalitis,but there was no significant correlation between the changes of bilateral frontal cortex metabolites and cogni

关 键 词：脑炎 磁共振波谱 N-甲基-D-天冬氨酸受体 

分 类 号：R373.3[医药卫生—病原生物学] R445.2[医药卫生—基础医学]