轻度认知障碍患者脑内MR波谱分析及其与认知功能相关性研究

发布时间：2018-07-04 15:58

本文选题：轻度认知功能损害 + 阿尔茨海默病　；参考：《苏州大学》2013年硕士论文

【摘要】：目的：利用磁共振波谱分析（MRS）技术对轻度认知障碍（MCI）、阿尔茨海默病（AD）患者及正常老年人双内侧颞叶及海马区局部脑代谢变化进行研究，，探讨MRS代谢指标与认知功能的关系及其在MCI和AD的诊断价值。方法：采用简易精神状态评价量表（MMSE）、临床痴呆评定量表（CDR）、阿尔茨海默病评价量表-认知分表（ADAS-Cog）等认知量表分别对MCI、AD和正常老年人各12例进行认知功能测试检查。应用GE公司生产的3.0T Signa HDxt超导磁共振扫描仪对所有入选的研究对象行常规MRI扫描，排除脑内其他疾病；随后对脑内感兴趣区（双侧海马及内侧颞叶）的1H-MRS采集。系统自动测出各代谢物浓度，并计算出各自相应的比值包括NAA/Cr，Cho/Cr，mI/Cr及NAA/mI。应用统计学软件比较MCI组、AD组和正常对照组各代谢物比值的差异，并将其与认知功能进行相关性分析。结果： 1.（1）双内侧颞叶1H-MRS各代谢物比值的变化： MCI组双内侧颞叶NAA/mI明显低于NC组，差异显著（P0.05）。AD组左内侧颞叶NAA/Cr、NAA/mI均明显低于NC组，差异显著（P0.05）；右内侧颞叶NAA/mI明显低于NC组，差异显著（P0.05），NAA/Cr低于NC组，差异不显著（P0.05）。AD组与MCI组相比，差异不显著（P0.05）；余代谢物比值差异不显著(P0.05)。（2）海马区1H-MRS各代谢物比值的变化： MCI组双侧海马NAA/mI明显均低于NC组，差异显著(P0.05)；mI/Cr明显高于NC组，差异显著(P0.05)。AD组双侧海马NAA/Cr、NAA/mI明显低于NC组，差异显著（P0.05）。AD组NAA/mI低于MCI组，差异显著(P0.05)；mI/Cr明显高于MCI组，差异显著(P0.05)。余代谢物比值差异不显著(P0.05)。 2.（1）MMSE评分与1H-MRS的相关性： MCI组MMSE延迟回忆亚项与左内侧颞叶NAA/Cr呈正相关（P0.05）；AD组与左侧海马区NAA/Cr、NAA/mI呈正相关（P0.05），视空间能力与右侧海马区NAA/Cr呈正相关（P0.05）。（2）ADAS-Cog评分与1H-MRS的相关性： MCI组ADAS-Cog单词回忆亚项与左内侧颞叶NAA/Cr呈负相关（P0.05），mI/Cr呈正相关（P0.05）；AD组与左侧海马区NAA/Cr、NAA/mI呈负相关（P0.05）。结论: 1. NAA/mI指标的变化早于NAA/Cr的改变，提示NAA/mI能更早地警示MCI的出现，可单独作为AD早期的诊断依据。 2. MMSE延迟回忆亚项的评分与左内侧颞叶NAA/Cr的相关性最为明显，提示认知功能评价MMSE延迟回忆亚项评分与磁共振波谱分析检查结合可作为MCI和AD早期诊断及鉴别诊断的重要工具，也可作为监测MCI病情进展的重要指标。
[Abstract]:Objective: to study the changes of regional brain metabolism in patients with mild cognitive impairment (MCI), Alzheimer's disease (AD) and the bilateral medial temporal lobe and hippocampus by magnetic resonance spectroscopy (Mrs). To explore the relationship between Mrs metabolism and cognitive function and its diagnostic value in MCI and AD. Methods: MMSE, CDR and ADAS-Cog were used to examine the cognitive function of 12 patients with MCIAD and 12 normal aged people. The 3.0T Signa HDxt superconducting magnetic resonance scanner produced by GE Company was used to scan all the subjects to exclude other diseases in the brain, and then 1H-MRS was collected from the regions of interest (bilateral hippocampus and medial temporal lobe). The system automatically measured the concentrations of each metabolite and calculated their respective ratios, including NAA / Cro / Cr / Cr and NAA / MI. Statistical software was used to compare the ratio of metabolites between AD group and normal control group in MCI group, and the correlation between the ratio of metabolites and cognitive function was analyzed. Results: (1) the ratio of 1H-MRS metabolites in bilateral medial temporal lobes: NAA / mi of bilateral medial temporal lobes in MCI group was significantly lower than that in NC group (P0.05), and the difference was significant (P0.05). NAA / Cr ~ (+) NAA / mi in left medial temporal lobe in AD group was significantly lower than that in NC group (P0.05). NAA / mi in the right medial temporal lobe was significantly lower than that in NC group (P0.05), and the difference was not significant in AD group (P0.05) compared with MCI group (P0.05). There was no significant difference in the ratio of residual metabolites (P0.05). The ratio of 1H-MRS metabolites in hippocampus was significantly lower in MCI group than in NC group, and the difference was significant (P0.05). The difference was significant (P0.05). The NAA / Cr of AD group was significantly lower than that of NC group, the difference was significant (P0.05). The difference between AD group and MCI group was significantly higher than that of MCI group (P0.05), and the difference was significant (P0.05). (1) the correlation between MMSE score and 1H-MRS: MMSE delayed recall subitem in MCI group was positively correlated with NAA / Cr in left medial temporal lobe (P0.05); In AD group, there was a positive correlation between NAA / Cr / NAA / mi in left hippocampal area (P0.05), and there was a positive correlation between visual spatial ability and NAA / Cr in right hippocampus (P0.05). (2). There was a negative correlation between ADAS-Cog word recall subitem and NAA / Cr in left medial temporal lobe (P0.05) in AD group (P0.05), and there was a positive correlation between ADAS-Cog score and NAA / Cr in left medial temporal lobe (P0.05). In AD group, there was a negative correlation between NAA / Cr and NAA / mI in left hippocampal area (P0.05). Conclusion: 1. The change of the index of NAA / mi was earlier than that of NAA / Cr, suggesting that NAA / mi could warn the emergence of MCI earlier and could be used as the basis for the early diagnosis of AD alone. 2. The correlation between the scores of MMSE delayed recall subitems and NAA / Cr in left medial temporal lobe was most significant, which suggested that the combination of cognitive function evaluation with magnetic resonance spectroscopy analysis can be used as an important tool for early diagnosis and differential diagnosis of MCI and AD. It can also be used as an important index to monitor the progression of MCI.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.16

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