路易体痴呆及阿尔茨海默病患者海马氢质子磁共振波谱研究

摘要

目的 研究路易体痴呆(dementia with Lewy bodies,DLB)及阿尔茨海默病(Alzheimer's disease,AD)患者双侧海马氢质子磁共振波谱(hydrogen proton magnetic resonance spectroscopy,1H-MRS)代谢物水平变化特点,探索海马1H-MRS在区分DLB和AD中的意义.方法 在3T场强条件下,对14例DLB、14例AD患者及15例正常对照(normal control,NC)双侧海马进行单体素1H-MRS采集,测定海马N-乙酰天门冬氨酸(N-acetylaspartate,NAA)、胆碱(choline,Cho)及肌醇(myo-inositol,mI)与肌酸(creatine,Cr)的比值.结果 三组海马1H-MRS测量值比较,左、右侧海马NAA/Cr值差异均有统计学意义(F=5.347,P=0.009;F=5.302,P=0.009).DLB组左侧海马NAA/Cr值(1.56±0.30)、AD组左侧海马NAA/Cr值(1.51±0.22)均低于NC组(1.84±0.35)(均P＜ 0.05).DLB组右侧海马NAA/Cr值(1.62±0.27)、AD组右侧海马NAA/Cr值(1.49±0.39)均低于NC组(1.90±0.37)(均P＜0.05).DLB组双侧海马NAA/Cr值略高于AD组,但差异无统计学意义(均P＞0.05).三组间双侧海马mI/Cr值、Cho/Cr值差异无统计学意义(均P＞0.05).结论 DLB、AD患者双侧海马存在神经元功能障碍,其代谢物水平不能有效区分DLB和AD.%Objective To investigate the characteristics of hydrogen proton magnetic resonance spectroscopy (1H-MRS) in the bilateral hippocampus in patients with dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) and their value in differentiating DLB from AD. Methods The metabolic ratios of N-acetylaspartate/Creatine (NAA/Cr), Myo-inositol (mI)/Cr and Choline (Cho)/Cr in the bilateral hippocampus were determined by using 1H-MRS in 14 patients with DLB, 14 patients with AD and 15 normal controls. Results The NAA/Cr in the bilateral hippocampus of patients with DLB (1.56 ± 0.30/1.62 ± 0.27) and AD (1.51 ± 0.22/1.49 ± 0.39) was significantly lower than that of the NC (1.84 ± 0.35/1.90 ± 0.37) (all P < 0.05). However, there was no significant difference in NAA/Cr between DLB and AD groups. There were no significant differences in the ratios of mI/Cr and Cho/Cr among the three groups. Conclusions Patients with DLB and AD have neuronal dysfunction in the bilateral hippocampus. The metabolic changes in the Hippocampus can not effectively differentiate DLB from AD.