慢性失眠障碍患者认知功能与核磁共振波谱成像的研究

目的 探讨慢性失眠障碍(Chronic insomnia disorder,CID)患者的认知功能和海马氢质子磁共振波谱成像(Proton magnetic resonance spectroscopy,¹H-MRS)特点。方法 收集自2017年1月1日-2020年1月1日就诊于新疆医科大学第五附属医院睡眠障碍门诊的60例CID患者,对照组选取同期门诊体检的60例无睡眠障碍的健康人群; 采用匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评估2组研究对象的睡眠质量; 分别采用简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估2组研究对象的总体认知功能; 应用¹H-MRS技术检测2组双侧海马N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)和肌酸(Cr)3种代谢物水平,并计算NAA/Cr和Cho/Cr比值。结果 CID组患者PSQI评分显著高于对照组(P<0.01); CID组MMSE评分与对照组比较无显著差异(P>0.05); CID组MoCA评分显著低于对照组(P<0.01),其中注意力、瞬时记忆、延时记忆以及视空间执行功能评分均显著低于对照组(P<0.01、0.01、0.01、0.05); CID组右侧海马NAA/Cr比值低于对照组(1.76±0.32 vs.2.06±0.48)(t=2.278,P=0.027); CID组双侧海马NAA/Cr比值无明显差异(t=1.425,P=0.168); C1D组患者PSQI总分及病程与MoCA评分呈负相关(r=-0.428,-0.355,P=0.006),与右侧海马NAA/Cr比值呈负相关(r=-0.352,-0.308,P=0.019)。结论 CID患者失眠严重程度及病程与MoCA评分、右侧海马NAA/Cr 比值有关,可能导致患者轻度认知功能障碍(MCI)及右侧海马可能存在神经元受损。

The study on cognitive function and nuclear magnetic resonance spectroscopy of patients with chronic insomnia

ObjectiveTo study the cognitive function and characteristics of proton magnetic resonance spectroscopy(¹H-MRS)in patients with chronic insomnia(CID).Methods A total of 60 CID patients from the sleep disorder clinic of the Fifth Affiliated Hospital of Xinjiang Medical University from January 1, 2017 to January 1, 2020, and 60 healthy people without sleep disorders who were examined in the clinic during the same period were collected as the control group. Pittsburgh sleep quality index(PSQI)was used to evaluate the sleep quality of the two groups. Mini-mental state examination Scale(MMSE)and Montreal cognitive assessment scale(MoCA)were used to evaluate the overall cognitive function of the two groups. ¹H-MRS technology was used to detect the levels of N-acetylaspartate(NAA), choline-containing compounds(Cho)and creatine(Cr)in the hippocampus of the two groups, and calculate the ratio of NAA / Cr and Cho / Cr.Results PSQI score of the CID group was significantly higher than that of the control group(P<0.05). MMSE score of the CID group was not significantly different from that of the control group(P>0.05). MoCA score of the CID group was significantly lower than that of the control group, attention, transient memory, delayed memory and visual space executive function of the CID group were significantly lower than those of the control group(P<0.05). NAA / Cr ratio in the right hippocampus of the CID group was lower than that in the right hippocampus of the control group(1.76±0.32 vs. 2.06±0.48)(t=2.278,P=0.027). The difference in NAA / Cr ratio between the bilateral hippocampus of the CID group was not statistically significant(t=1.425,P=0.168). The total PSQI score and disease course of the C1D group were negatively correlated with the MoCA score(r=-0.428,P=0.006), and were also negatively correlated with NAA / Cr ratio(r=-0.352, P=0.019).Conclusion The severity of insomnia and the course of disease in patients with CID was related to MoCA score, NAA / Cr ratio in the right hippocampus of CID patients, which might be lead to mild cognitive impairment(MCI)and possible neuronal damage in the right hippocampus.