轻度阿尔茨海默病患者治疗前后海马亚区体积的磁共振成像研究

目的观察轻度阿尔茨海默病(AD)患者盐酸多奈哌齐治疗前后海马MRI亚区体积变化,为轻度AD的临床早期诊疗提供影像学帮助。方法2017年1月至2018年6月,轻度AD患者50例,随机分为治疗组(口服盐酸多奈哌齐)和安慰剂组,性别和年龄匹配的老年志愿者25例为对照组。治疗前和治疗6个月后,行MRI 3D快速场回波序列,采用FreeSurfer自动获取双侧海马各亚区体积进行组间比较,同时分析治疗前后简易精神状态检查(MMSE)评分变化。结果治疗前,与对照组比较,患者组左侧海马CA1、CA2-3和CA4-DG,右侧CA1和CA2-3体积缩小(t>2.294,P<0.05)。治疗后,治疗组左侧CA4-DG亚区体积较安慰剂组增大(t=2.196,P<0.05),而双侧CA1和CA2-3体积有增大趋势,但无显著性差异(t<1.888,P>0.065)。治疗后,治疗组MMSE评分较安慰剂组增加(t=2.764,P<0.05)。结论轻度AD患者药物治疗前后双侧海马不同亚区体积存在改变,左侧CA4-DG体积可能作为临床早期诊断和评价疗效的辅助指标。

Hippocampal Subfield Volumes before and after Treatment for Mild Alzheimer's Disease: Study with Magnetic Resonance Imaging

Objective To investigate the hippocampal subfield volumes before and after taking hydrochloric donepezil in patients with mild Alzheimer's disease (AD).Methods From January, 2017 to June, 2018, 25 mild AD patients accepted hydrochloric donepezil (treatment group), 25 patients accepted placebo (placebo group) and 25 age- and gender-matched healthy old people (control group) were scanned with magnetic resonance imaging (MRI) under 3D-T₁ TFE sequence before and after a six-month treatment, and the automated segmentation of the hippocampus subfields was fulfilled with FreeSurfer and the hippocampus subfield volumes were compared, while the patients were assessed with Mini-Mental State Examination (MMSE).Results Compared with the control group, the volumes of left CA1, CA2-3 and CA4-DG, and right CA1 and CA2-3 were reduced in patients before treatment (t > 2.294, P< 0.05). The volume of left CA4-DG increased in the treatment group compared with that of the placebo group after treatment (t = 2.196, P< 0.05), and the volume of bilateral CA1 and CA2-3 tended to increase but not significantly (t < 1.888, P> 0.065). The MMSE score was more in the treatment group than in the placebo group after treatment (t = 2.764, P< 0.05).Conclusion The association with asymmetric atrophy in the hippocampal subfields has been found in mild AD patients, especially in left CA4-DG, which may be used as a valuable marker for diagnosis and evaluation for treatment at early stage.