施海姗钟笑梅侯乐罗新妮陈辛茹刘莎郑东宁玉萍

麻痹性痴呆患者磁共振波谱与认知障碍的相关研究☆

施海姗*钟笑梅*侯乐*罗新妮*陈辛茹*刘莎**郑东*宁玉萍*

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。

麻痹性痴呆 海马区 氢质子磁共振波谱

【Abstract】Objective We aimed to use1H-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.

【Key words】General paresis of insane Hippocampus Hydrogen proton magnetic reasonance spectroscopy

麻痹性痴呆（general paresis of insane，GPI）是由梅毒螺旋体（苍白螺旋体）侵犯大脑引起的慢性炎症改变，是神经梅毒最严重的一种类型［1］。国内学者研究表明，GPI患者的认知功能的损害模式与阿尔茨海默病（Alzheimer’s Disease，AD）类似［2-3］，神经影像学的研究提示GPI患者也存在内侧颞叶、海马区明显萎缩［4］。氢质子磁共振波谱（hydro⁃genprotonmagneticresonancespectroscopy，1H-MRS）的研究已较一致发现，AD患者双侧海马区N-乙酰天冬氨酸（N-acetylaspartate，NAA）水平下降［5-7］。既往研究发现GPI患者海马区也存在类似的神经元损害，与AD患者类似［8］。……