【作者】 赵强；

【导师】 韩恩吉；

【作者基本信息】 山东大学 ， 神经病学， 2007， 硕士

【摘要】 目的：Alzheimer病（AD）患者的氢质子磁共振波谱（¹H-MRS）与神经心理学（MMSE、ADL、ADAS-Cog）相关性研究。方法：20例AD患者符合以下诊断标准：MMSE筛选认知障碍，痴呆诊断符合美国精神疾病诊断及统计手册第四版（DSM-Ⅳ）标准；AD诊断符合美国国立神经病、语言交流障碍和卒中研究所—老年性痴呆及相关疾病协会（NINCDS-ADRDA）制定的“可能AD”和“很可能AD”诊断标准。入组过程中还应用了Hachinski缺血指数量表（HIS）和Hamilton抑郁量表进一步除外血管性痴呆和假性痴呆（抑郁症）。神经心理学检查除MMSE外，还进行了ADL和ADAS-Cog、量表检查。MMSE为简易精神状态量表，系国际上通用的认知障碍筛选量表，共11项目，总分30分。得分愈低，认知障碍愈严重。根据国际标准：24分为分界值，18-24分为轻度认知障碍，16-17分为中度认知障碍，≤15分为重度认知障碍。ADL为日常生活能力量表，大于20分有不同程度的功能下降，最高80分。分数愈高，病情愈重。分成高分组（≥41分）、中分组（31-40分）、低分组（21-30分）。ADAS-cog为认知行为检测量表，最高分75分，分数愈高，病情愈重。也分为高分组（≥61分）、中分组（51-60分）、低分组（41-50分）。磁共振波谱检查应用山东大学齐鲁医院GE EXCITEⅡSigna 3.0T磁共振系统。首先常规扫描T₁WI、T₂WI、及T₂Flair序列，除外颅脑器质性疾病。¹H-MRS使用8通道头线圈作为发射和接收线圈，以听眦线为扫描基线，采集常规轴位T₁WI图像，用以定位。采用PROBE-J序列进行单体素采集，起始TE=35ms，TR=2000ms，NEX=6，FOV=24，采集矩阵1×1。感兴趣区（ROI）置于左、右两侧海马，双侧海马选取体素的上下、左右、前后径大小分别为15mm×15mm×20mm。扫描完成后，在主机上用SAGE软件进行后处理。同时获得波谱曲线、各代谢物的峰下面积，计算峰下面积比值NAA／Cr、MI／Cr、Cho／Cr。（NAA：N-乙酰天门冬氨酸；MI：肌醇；Cho：胆碱；Cr-肌酸）。结果：NAA／Cr、MI／Cr比值与MMSE、ADL和ADAS-Cog有显著的相关性，各分组之间差异有显著性（P＜0.05）。海马区NAA／Cr比值随痴呆的严重程度加重而降低；MI／Cr比值与NAA／Cr比值相反，海马区MI／Cr比值随痴呆的严重程度加重而增加。Cho／Cr比值与MMSE、ADL和ADAS-Cog无相关性，各分组之间无显著性差异（P＞0.05）。结论：应用磁共振波谱测量海马区NAA／Cr和MI／Cr比值对评估AD患者的病情严重程度有一定的临床意义。随着今后研究方法的不断完善，磁共振波谱测量海马区NAA／Cr和MI／Cr比值可能成为一个诊断和评估AD患者病情严重程度的生物学指标。更多还原

【Abstract】 Objective: To sduty the relativity of ¹H-MRS and Neuropsychology test（MMSE、 ADL、 ADAS-Cog） in patients with Alzheimer’s Disease. Materials and Method: 20 subjects of AD were consistent with the standard below: cognitive handicap was sieved by MMSE, the diagnosis of aphronesia corresponds with the 4th of Diagnostic and Statistical Manual of Mental Disorders; the diagnosis of AD fits the standard of possible AD or probable AD from NINCDS-ADRDA . In the entrance we exclude vascular dementia（VD） and pseudodementia by HIS and Hamilton depression scale. Except MMSE, we have made ADL 和 ADAS-Cog, too. MMSE is a MINI-Mental State Examination, which is universally international cognitive handicap screening , 11 items, 30 points altogether. Cognitive handicap will be worse as the points are lower. On the basis of international standard, the score of 24 points is the dividing line , 18-24 is light cognitive handicap, 16-17 is mediate cognitive handicap, ≤15 is the worst cognitive handicap. ADL is an activity of daily living measuring scale, it shows different degree if function degression over 20 points , the highest points are 80. The more the points are , the worse the state of an illness is. We fractionate the points as high group（≥61）, middle group （51-60） and low group（41-50）. ADAS-Cog is a cognitive behavior measuring scale, the highest points are 75, just like the ADL, the more the points are , the worse the state of an illness is. We fractionate the points as high group（≥41）, middle group （31-40） and low group（21-30）, too. Adoptting GE EXCITEII Signa 3. 0T magnetic resonance of Shandong university Qilu Hospital, we first routinly scan TiWI、 T₂WI、 and T₂Flair as routine , exclude brain parenchymal disease. We use 8 passages as launch and receive coil in ¹H-MRS, made canthomeatal line as time base . to gather normal axial view T₁WI image for location. We use PROBE-J sequence to carry out simple voxel collection and the initiation state is TE=35ms, TR=2000ms, NEX=6 , FOV=24, to collect matrix 1×1. Region of interest（ROI） is in both sides of cornu ammonis, in which we choose up and down, left and right, and anteroposterior diameter to discern 15mm ×15mm×20mm. After scanning, we made after-processing in the main frame using SAGE software. Then we can get wave spectrum curve, areas of each metabolin , and calculate ratio of the areas below the ratio of NAA/Cr、 MI/Cr、 Cho/Cr summito （NAA: N-acetylaspartate; MI: myo-inositol; Cho : choline; Cr: creatine） .Results: there is a noticeable relativity between the ratio of NAA/Cr、 MI/Cr and the results of MMSE, ADL and ADAS-Cog, and there is a significant discrepancy between each groups（P<0. 05）. The ratio of NAA/Cr in regions of hippocampus is decreasing with the aggravation of dementia; On the contrary, the ratio of MI/Cr is opposite to that of NAA/Cr, and the ratio of MI/Cr in regions of hippocampus increases with the aggravation of dementia; the ratio of Cho/Cr has nothing to do with the results of MMMSE、 ADL and ADAS-Cog, there is no significant difference between them（P>0. 05）. Conclusion: There is some clinical significance in evaluating the seriousness of AD patients using the ratio of NAA/Cr and MI/Cr in the region of hippocampus measured by magnetic resonance spectroscopy. With the consecutive consummate in the research methods , the measured ratio of NAA/Cr、 MI/Cr by MRS will possibly be a biological parameter in theevaluation of seriousness of AD.更多还原