麻痹性痴呆患者磁共振波谱与认知障碍的相关研究

摘要

目的：应用氢质子磁共振波谱（1H-proton magnetic resonance spectroscopy，1H-MRS）技术，探索麻痹性痴呆（general paresis of the insane，GPI）患者海马区代谢物水平特点。方法纳入GPI患者52例，健康中老年对照（normal control，NC）38例进行双侧海马区1H-MRS检查，比较N-乙酰天门冬氨酸（N-acetylaspartate，NAA）/肌酸、胆碱/肌酸，NAA/胆碱，胆碱/NAA和肌醇/肌酸的水平；并同日进行简易精神状态检查（MMSE）、蒙特利尔认知检查量表（MoCA）量表评定，探索GPI患者海马区代谢物水平与病程严重程度的相关性。结果 GPI和NC两组比较：GPI组的双侧海马区NAA/Cr水平较NC组明显下降，差异有统计学意义（P＜0.001）。不同痴呆程度的GPI患者比较：重度痴呆组左侧海马区NAA/Cr水平较轻度痴呆组明显下降，差异有统计学意义（P＜0.001)。重度痴呆组右侧海马区的Cho/Cr和mI/Cr较轻度痴呆组升高（P＜0.05）。GPI组左侧海马区的NAA/Cr与MMSE、MoCA呈正相关（P＜0.001）。结论 GPI患者均存在双侧海马区神经元损伤。且痴呆程度越重，左侧海马神经元损害越严重。%Objective We aimed to use 1H-MRS to characterize metabolite concentrations in the bilateral hippo⁃campus in GPI patient. Methods Metabolite ratios in the bilateral hippocampus were compared between patients with GPI (n=52) and Normal Control (NC) (n=38). Clinical neurological tests were measured in all subjects and were correlat⁃ed to the metabolite concentrations. Results The GPI patients showed significantly lower concentrations of N-acetylas⁃partate(NAA)/creatine(Cr) ratios in the bilateral hippocampus region compared to the NC subjects. There was significant⁃ly difference in the NAA/Cr ratios between the mild GPI dementia and the severe GPI dementia groups on the left hippo⁃campus region. We found that the NAA/Cr ratios concentrations were positively correlated with Mini Mental state Exami⁃nation (MMSE) and Montreal Cognitive Assessment scale (MoCA) scores in the left hippocampus region and the mI/Cr ra⁃tios concentrations were positively correlated. Conclusions GPI Patients have neuronal dysfunction in the bilateral hippo⁃campus. The severity of cognitive impairments is associated with the severity of the damage in the left side.