氢质子磁共振波谱在帕金森病分型和与特发性震颤鉴别的价值  

The value of proton magnetic resonance spectroscopy in the diagnosis of different subtypes of Parkinson's disease and their differential diagnosis from essential tremor

作　　者：卢俏丽[1] 宋歌 李晨[1] Lu Qiaoli;Song Ge;Li Chen(Department of Neurology,Tianjin 5th Central Hospital,Tianjin 300450,China;Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014040,China)

机构地区：[1]天津市第五中心医院神经内科,天津300450 [2]内蒙古科技大学包头医学院,包头014040

出　　处：《中华老年医学杂志》2022年第11期1316-1320,共5页Chinese Journal of Geriatrics

基　　金：滨海新区卫生和计划生育委员会(2018BWKQ037)。

摘　　要：目的利用氢质子磁共振波谱(1H-MRS)技术,比较不同运动障碍亚型帕金森病(PD)患者和特发性震颤(ET)患者在不同脑区N-乙酰基天门冬氨酸(NAA)/肌酸(Cr)、NAA/胆碱复合物(Cho)和Cho/Cr值的差异,为PD的分型诊断及与ET的早期鉴别诊断提供影像学依据。方法回顾性分析,入选2018年6月至2021年5月在天津市第五中心医院神经内科门诊和住院部诊断的PD(92例)和ET患者及健康体检者,分为4组:(1)TD组:震颤为主型PD患者45例;(2)PIGD组:姿势异常步态障碍为主型PD患者47例;(3)ET组44例;(4)对照组40例。收集入选者临床资料,对各组双侧基底核和小脑皮质区进行1H-MRS检测,比较各组基底核及小脑皮质区代谢物NAA/Cr、NAA/Cho及Cho/Cr值的差异。结果TD组、PIGD组患者基底核区NAA/Cr为(1.65±0.19)、(1.48±0.11),NAA/Cho为(1.55±0.20)、(1.46±0.17),低于对照组和ET组的(1.92±0.28)、(2.08±0.34)和(2.10±0.16)、(2.23±0.23),差异有统计学意义(均P<0.05),Cho/Cr值(1.07±0.25)和(1.02±0.13)高于对照组(0.92±0.27)及ET组患者(0.91±0.21),均P<0.05;基底核区NAA/Cr值PIGD组低于TD组患者(P<0.05);ET组患者基底核区NAA/Cr、NAA/Cho及Cho/Cr值与对照组比较差异无统计学意义(均P>0.05)。ET组小脑皮质区NAA/Cr(0.72±0.16)和NAA/Cho(0.78±0.14)值低于对照组(0.92±0.20)和(1.12±0.17)、TD组(0.90±0.14)和(1.10±0.13)及PIGD组(0.89±0.25)和(1.08±0.17),Cho/Cr值高于对照组、TD及PIGD组,(0.94±0.13)比(0.81±0.20)、(0.82±0.13)、(0.82±0.25),均P<0.05;TD组、PIGD组及对照组小脑皮质区NAA/Cr、NAA/Cho及Cho/Cr值比较,差异无统计学意义(均P>0.05)。结论1H-MRS可检测脑部的代谢改变,PD患者基底核区和ET患者小脑皮质区神经元的损伤或丢失,有望为PD早期诊断、分型及与ET鉴别诊断的客观影像学依据。Objective To compare the differences in N-acetylaspartate/creatine(NAA/Cr),N-acetylaspartate/choline(NAA/Cho)and choline/creatine(Cho/Cr)in different brain regions of patients with different motor subtypes of Parkinson's disease(PD)or essential tremor(ET)using proton magnetic resonance spectroscopy(1H-MRS),and to provide an imaging basis for the diagnosis of different PD subtypes and their differential diagnosis from ET.Methods 92 PD outpatients and inpatients,ET patients and healthy individuals receiving check-ups at our hospital from June 2018 to May 2021were retrospectively enrolled and divided into four groups:tremor-dominant(TD)(n=45),postural instability and gait disorders(PIGD)(n=47),ET(n=44),and healthy controls(n=40).Participant clinical information was collected and bilateral basal ganglia and cerebellar cortex 1H-MRS examinations were performed for each group.Values of NAA/Cr,NAA/Cho and Cho/Cr of the basal ganglia and the cerebellar cortex were compared between the groups.Results NAA/Cr and NAA/Cho values in the basal ganglia were 1.65±0.19 and 1.55±0.20 for the TD group and 1.48±0.11 and 1.46±0.17 for the PIGD group,respectively,lower than in the control group(NAA/Cr:1.92±0.28;NAA/Cho:2.08±0.34)and the ET group(NAA/Cr:2.10±0.16;NAA/Cho:2.23±0.23),with statistical significance(P<0.05),whereas Cho/Cr values for the former two groups(TD:1.07±0.25;PIGD:1.02±0.13)were higher than in the latter two groups(control:0.92±0.27;ET:0.91±0.21),with statistical significance(P<0.05).NAA/Cr values of the basal ganglia in the PIGD group were lower than in the TD group(P<0.05).NAA/Cr,NAA/Cho and Cho/Cr values of the basal ganglia in the ET group were not statistically different compared with those in the control group(P>0.05).In the cerebellar cortex,NAA/Cr(0.72±0.16)and NAA/Cho(0.78±0.14)in the ET group were lower than in the control group(0.92±0.20)and(1.12±0.17),the TD group(0.90±0.14);(1.10±0.13)and the PIGD group(0.89±0.25)and(1.08±0.17)(P<0.05).NAA/Cr,NAA/Cho and Cho/Cr values of the cerebell

关 键 词：帕金森病 特发性震颤 磁共振波谱学 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]