磁共振波谱在遗忘型与非遗忘型轻度认知障碍鉴别诊断中的应用价值

doi:10.3877/cma.j.issn.2095-655X.2015.03.002

目的

探讨磁共振波谱(¹H-MRS)在遗忘型轻度认知障碍(aMCI)与非遗忘型轻度认知障碍(naMCI)鉴别诊断中的应用价值。

方法

对明确诊断的25例aMCI患者(aMCI组)、22例naMCI患者(naMCI组)及20例认知功能正常老年人(NC组)，行多体素¹H-MRS检查，以左侧海马、扣带后回及额叶为兴趣区，检测N-乙酰天门冬氨酸(NAA)、谷氨酸(Glu)、肌醇(mI)及肌酸(Cr)的峰下面积。使用SPSS 17.0软件包对所测定的数据进行分析，3组间NAA/Cr、mI/Cr及Glu/Cr值的比较使用单因素方差分析，组间两两比较用最小差值显著法(LSD)进行统计分析。

结果

aMCI组和naMCI组在左侧海马的NAA/Cr值(分别为1.09±0.11、1.07±0.08)均低于NC组(1.20±0.21)，差异有统计学意义(F＝10.23，P<0.05)；aMCI组和naMCI组在左侧扣带后回的NAA/Cr值(分别为1.02±0.09、1.07±0.10)也低于NC组(1.22±0.18)，差异有统计学意义(F＝8.73，P<0.05)；aMCI组和naMCI组在海马与扣带后回的NAA/Cr值差异无统计学意义(F＝1.54，P>0.05)。aMCI组扣带后回Glu/Cr值(0.35±0.04)低于naMCI组与NC组(0.43±0.02、0.42±0.05)，差异有统计学意义(F＝8.44，P<0.05)；3组间的Glu/Cr值在海马和扣带后回的均差异无统计学意义(F＝0.38，0.36；P>0.05)。aMCI组在海马的mI/Cr值(0.66±0.07)高于naMCI组和NC组(分别为0.39±0.04、0.41±0.04)，差异有统计学意义(F＝11.47，P<0.05)；aMCI组在扣带后回的mI/Cr值(0.62±0.05)高于naMCI组和NC组(分别为0.42±0.03、0.44±0.04)，差异有统计学意义(F＝9.41，P<0.05)；naMCI组在额叶区的mI/Cr值(0.58±0.04)高于aMCI组和NC组(分别为0.43±0.03、0.41±0.03)，差异有统计学意义(F＝7.83，P<0.05)。

结论

aMCI及naMCI组患者脑内mI及Glu代谢存在区域性的差异，¹H-MRS为临床鉴别aMCI及naMCI提供了有效的依据。

关键词: 认知障碍, 痴呆, 磁共振波谱学

Objective

To investigate the value of hydrogen proton magnetic resonance spectroscopy (¹H-MRS) in the differential diagnosis of amnestic mild cognitive impairment (aMCI) and non-amnestic mild cognitive impairment (naMCI).

Methods

Twenty-five cases of aMCI patients were enrolled, twenty-two cases with naMCI and twenty subjects were elderly with normal cognitive function (NC). They all received examination of ¹H-MRS.The regions of interest were examined, including the left hippocampus, the posterior cingulate gyrus, and the frontal lobes.The area under the peak was determined for N-acethyl aspartate (NAA), glutamate (Glu), inositol (mI) and creatine (Cr). The ratios of NAA/Cr, Glu/Cr and mI/Cr were compared in different brain regions among the three groups with SPSS 17.0.

Results

Compared with the NC group, the ratio of NAA/Cr in the left hippocampus group was significantly lower than that in the aMCI and naMCI groups (1.09±0.11, 1.07±0.08, 1.20±0.21; t=0.247, 0.312; all P<0.05), and the ratio of NAA/Cr in the left posterior cingulate gyrus group was also significantly reduced with those in the aMCI and naMCI groups (1.02±0.09, 1.07±0.10, 1.22±0.18; t=0.442, 0.381; all P<0.05). However, no significant difference in the ratio of NAA/Cr in any brain region were observed between aMCI and naMCI groups (t=0.021, 0.036; P>0.05). The Glu/Cr ratio in the posterior cingulate gyrus of the aMCI group decreased significantly compared with that in the naMCI and NC groups (0.35±0.04, 0.43±0.02, 0.42±0.05; t=0.474, 0.405; all P<0.05). No significant difference in the Glu/Cr ratio was observed in other brain regions among the three groups (F=0.382, 0.363; all P>0.05). The mI/Cr ratio in the hippocampus was significantly bigger in the aMCI group than that in the naMCI and NC groups (0.66±0.07, 0.39±0.04, 0.41±0.04; t=0.293, 0.247; all P<0.05), and the mI/Cr ratio in the posterior cingulate gyrus was also significantly higher in the aMCI group than that in the naMCI and NC groups (0.62±0.05, 0.42±0.03, 0.44±0.04; t=0.255, 0.261; all P<0.05). The mI/Cr ratio in the frontal lobes of the naMCI group increased significantly compared with that in the aMCI and NC groups(0.58±0.04, 0.43±0.03, 0.41±0.03; t=0.174, 0.226; all P<0.05).

Conclusions

Regional differences of mI and Glu metabolism are found in brain tissues of patients with aMCI and naMCI.¹H-MRS is an effective method in the differential diagnosis of aMCI and naMCI.

Key words: Cognition impairment, Dementia, Magnetic resonance spectroscopy

表1 aMCI组、naMCI组与NC组受试者临床特征比较

组别	例数	性别(例，男/女)	年龄(岁，±s)	教育程度(年，±s)
aMCI组	25	12/13	67.54±6.12	9.2±2.1
naMCI组	22	10/12	69.34±7.01	9.7±3.4
NC组	20	9/11	67.73±5.84	9.1±2.3
统计值	?	χ²＝0.41	F＝0.01	F＝0.12
P值	?	>0.05	>0.05	>0.05

表1 aMCI组、naMCI组与NC组受试者临床特征比较

组别	例数	性别(例，男/女)	年龄(岁，±s)	教育程度(年，±s)
aMCI组	25	12/13	67.54±6.12	9.2±2.1
naMCI组	22	10/12	69.34±7.01	9.7±3.4
NC组	20	9/11	67.73±5.84	9.1±2.3
统计值	?	χ²＝0.41	F＝0.01	F＝0.12
P值	?	>0.05	>0.05	>0.05

表2 aMCI组、naMCI组与NC组受试者¹H-MRS的NAA/Cr值比较(±s)

组别	例数	左海马	左扣带后回	左额叶
aMCI组	25	1.09±0.11^ab	1.02±0.09^ab	1.19±0.12
naMCI组	22	1.07±0.08^a	1.07±0.10^a	1.18±0.12
NC组	20	1.20±0.21	1.22±0.18	1.19±0.10
F值	?	10.23	8.73	1.54
P值	?	<0.05	<0.05	>0.05

表2 aMCI组、naMCI组与NC组受试者¹H-MRS的NAA/Cr值比较(±s)

组别	例数	左海马	左扣带后回	左额叶
aMCI组	25	1.09±0.11^ab	1.02±0.09^ab	1.19±0.12
naMCI组	22	1.07±0.08^a	1.07±0.10^a	1.18±0.12
NC组	20	1.20±0.21	1.22±0.18	1.19±0.10
F值	?	10.23	8.73	1.54
P值	?	<0.05	<0.05	>0.05

表3 aMCI组、naMCI组与NC组受试者¹H-MRS的Glu/Cr值比较(±s)

组别	例数	左海马	左扣带后回	左额叶
aMCI组	25	0.47±0.06	0.35±0.04	0.43±0.05
naMCI组	22	0.46±0.05	0.43±0.02	0.42±0.03
NC组	20	0.44±0.06	0.42±0.05	0.45±0.04
F值	?	0.38	8.44	0.36
P值	?	>0.05	<0.05	>0.05

表3 aMCI组、naMCI组与NC组受试者¹H-MRS的Glu/Cr值比较(±s)

组别	例数	左海马	左扣带后回	左额叶
aMCI组	25	0.47±0.06	0.35±0.04	0.43±0.05
naMCI组	22	0.46±0.05	0.43±0.02	0.42±0.03
NC组	20	0.44±0.06	0.42±0.05	0.45±0.04
F值	?	0.38	8.44	0.36
P值	?	>0.05	<0.05	>0.05

表4 aMCI组、naMCI组与NC组受试者¹H-MRS的mI/Cr值比较(±s)

组别	例数	左海马	左扣带后回	左额叶
aMCI组	25	0.66±0.07	0.62±0.05	0.43±0.03
naMCI组	22	0.39±0.04	0.42±0.03	0.58±0.04
NC组	20	0.41±0.04	0.44±0.04	0.41±0.03
F值	?	11.47	9.41	7.83
P值	?	<0.05	<0.05	<0.05

表4 aMCI组、naMCI组与NC组受试者¹H-MRS的mI/Cr值比较(±s)

组别	例数	左海马	左扣带后回	左额叶
aMCI组	25	0.66±0.07	0.62±0.05	0.43±0.03
naMCI组	22	0.39±0.04	0.42±0.03	0.58±0.04
NC组	20	0.41±0.04	0.44±0.04	0.41±0.03
F值	?	11.47	9.41	7.83
P值	?	<0.05	<0.05	<0.05

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The value of hydrogen proton magnetic resonance spectroscopy in the differential diagnosis of amnestic and non-amnestic mild cognitive impairment

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The value of hydrogen proton magnetic resonance spectroscopy in the differential diagnosis of amnestic and non-amnestic mild cognitive impairment