图雷特综合征患者对指运动切换的功能磁共振研究

目的 分析图雷特综合征(TS)患者在运动切换时脑激活特点,初步探讨TS患者抽动触发的可能机制.方法 14例TS患者(TS组)和14名年龄、性别相匹配的健康志愿者(对照组),用3.0T超导磁共振扫描系统进行功能MRI扫描,对比分析在对指运动转换过程中TS患者和健康志愿者的脑激活特点.结果 两组受试者激活相同的脑区:对侧的中央前后回、对侧扣带回、对侧额叶内侧回、同侧小脑半球;激活不同的脑区:附加右手对指运动时,左侧中央前后回激活体积( cm3) TS组(8.024±0.071)大于对照组(6.480±0.026),两者差异有统计学意义(t=3.026,P＜0.01);附加左手对指运动时,TS组(6.192±0.019)右侧中央前后回的激活体积大于对照组(5.608±0.037),两者差异有统计学意义(t=2.752,P＜0.05);TS组无岛叶激活,对照组出现对侧岛叶激活;TS组出现对侧丘脑激活,而对照组无丘脑激活.结论 丘脑在TS的发病机制中具有重要的作用,岛叶、扣带回、顶叶皮质环路可能是异样感觉和抽动发作前驱不适的结构和功能基础,TS患者从静止到运动的触发启动和(或)与一种运动到另一种运动的触发启动所需要的条件功能区可能存在差异.     

轻度认知损害患者氢质子磁共振波谱随访研究

目的回顾分析并总结轻度认知损害(MCI)患者认知功能转归及脑组织代谢物氢质子磁共振波谱(~1H-MRS)特点。方法采用简易智能状态检查量表(MMSE)和蒙特利尔认知评价量表(Mo CA)评价75例轻度认知损害患者和17例性别、年龄、受教育程度相匹配的正常对照者的认知功能,1H-MRS检测左侧海马和左侧额叶代谢物[包括N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、肌醇(m I)、谷氨酸复合物(Glx)]表达变化。结果与正常对照者相比,轻度认知损害患者左侧海马和左侧额叶Glx/Cr比值均降低(P=0.030,0.030)。至随访结束时,MCI组7例(9.33%)进展为阿尔茨海默病、55例(73.33%)认知功能无变化、13例(17.33%)逆转为认知功能正常;正常对照组13例(13/17)认知功能功能无变化,2例(2/17)进展为轻度认知损害,无一例进展为阿尔茨海默病。不同认知功能转化亚组中仅MCI-MCI组患者Glx/Cr比值高于MCI-AD组(P=0.040)。结论左侧海马和左侧额叶Glx/Cr比值降低可能是轻度认知损害患者认知功能恶化较敏感的生物学指标,尚待扩大样本量、延长随访时间深入研究。     

慢性精神分裂症患者双侧海马质子磁共振波谱成像研究

目的 利用质子磁共振波谱(~1H-MRS)研究慢性精神分裂症患者双侧海马生化物质的变化.方法 选择武警广东总队医院神经外科自2007年1月至2009年6月收治的慢性精神分裂症患者25例做为患者组,门诊体检正常志愿者25例为对照组,利用~1H-MRS测量2组成员双侧海马N-乙酰天门冬氨酸(NAA),胆碱复合物(Cho)和肌酸--磷酸肌酸复合物(Cr)含量,计算NAA/Cr和Cho/Cr的比值.结果 慢性精神分裂症患者双侧海马NAA/Cr的比值(左侧2.05±0.14,右侧1.98±0.17)低于正常对照组(左侧2.19±0.13,右侧2.17±0.14),差异有统计学意义(P<0.05);Cho/Cr比值(左侧1.30±0.12,右侧1.25±0.18)高于正常对照组(左侧1.04±0.15,右侧0.95±0.13),差异有统计学意义(P<0.05).结论 慢性精神分裂症患者双侧海马可能存在神经元的缺失或功能损伤,并且伴有膜磷脂代谢紊乱.     

轻度认知障碍和阿尔茨海默病的边缘系统氢质子磁共振波谱特点

目的探讨海马和扣带回后部氢质子磁共振波谱(’H-MRS)改变在轻度认知障碍(MCI)和阿尔茨海默病(AD)早期诊断中的作用。方法应用’H-MRS技术检测15名健康老年人、15例MCI患者及15例AD患者脑内边缘系统的代谢物水平,对检测的N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌酸复合物(Cr)和肌醇(mI)波谱数据进行比较分析。结果 AD组与健康对照组和MCI组相比,海马部位的mI/Cr均升高(均P0.05),NAA/mI降低(均P0.05);随病情进展,扣带回后部的mI/Cr呈递增趋势(P0.05),NAA/mI呈递减趋势(P0.05);AD组和MCI组扣带回后部的NAA/mI与健康对照组的差别程度大于海马部位(P=0.001,P=0.019)。结论扣带回后部的mI/Cr和NAA/mI有助于鉴别健康老人和AD患者;海马部位的NAA/mI有助于鉴别痴呆和非痴呆;MRS在诊断AD和MCI方面有一定辅助作用。     

麻痹性痴呆与阿尔茨海默病患者海马区氢质子磁共振波谱特点

目的 应用氢质子磁共振波谱(1 H-MRS)技术,探索麻痹性痴呆(GPI)患者、阿尔茨海默病(AD)患者和健康中老年人海马区代谢物水平特点.方法 纳入GPI患者35例,AD患者27例,健康中老年对照38名进行双侧海马区1 H-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)评定,探索GPI、AD患者海马区代谢物水平与病程严重程度的相关性.结果 GPI、AD组双侧海马区的NAA/肌酸均显著低于健康对照组(左侧1.48 ±0.25、1.52±0.28和1.71 ±0.36,F=5.928,P=0.004;右侧 1.47±0.38、1.62±0.36和1.82±0.42,F=7.309,P=0.001),GPI组右侧海马区的胆碱/NAA (0.68±0.48)显著高于AD组(0.49 ±0.15)和健康对照组(0.53±0.14),差异有统计学意义(P =0.024,P=0.045).GPI组和AD组海马区各代谢物水平与MMSE、MoCA评分均无显著相关.结论 GH和AD患者均存在双侧海马区神经元损伤.     

抑郁症首次发病患者额叶三维磁共振氢质子波谱分析研究

目的探讨抑郁症首次发病患者额叶灰、白质可能存在的神经生化异常。方法对24例首次发病抑郁症患者(抑郁症20例,双相障碍抑郁发作者4例;抑郁症组)进行磁共振常规扫描及应用三维磁共振氢质子波谱(1HMRS)检查,测量双侧额叶背外侧白质和前部扣带回皮质的N-乙酰天门冬氨酸(NAA)、胆碱复合物(CHO)、肌醇(MI)和肌酸(CR)的绝对值,计算NAA、CHO、MI与CR的比值,并与21名正常对照者(对照组)作比较。结果(1)抑郁症组患者前额叶扣带回皮质CHO[(772±59)MMOL/L]、MI[(131±39)MMOL/L]的绝对值及CHO/CR(2·3±0·4)、MI/CR(0·39±0·14)均高于对照组[分别为(663±70)MMOL/L,(99±26)MMOL/L,2·0±0·4,0·30±0·01],差异均有统计学意义(P均<0·01);而NAA的绝对值及NAA/CR与对照组的差异无统计学意义(P>0·05)。(2)抑郁症组患者额叶背外侧白质内NAA、CHO、MI的绝对值以及NAA/CR、CHO/CR、MI/CR的比值与对照组的差异均无统计学意义(P均>0·05)。结论抑郁症患者额叶扣带回皮质的CHO、MI绝对值以及CHO/CR、MI/CR比值均增高。     

轻度阿尔茨海默病患者磁共振成像及磁共振氢质子波谱研究

目的　探讨磁共振成像 (magneticresonanceimaging,MR)及磁共振氢质子波谱 (1H magneticresonancespectroscopy ,1H MRS)对轻度阿尔茨海默病 (Alzheimerdisease ,AD)患者的早期诊断。方法　对 18例临床确诊轻度AD患者和 2 0名正常对照者的MR及1H MRS进行分析 :MR上观察两组的海马回钩间距 (AB)及同层颅腔左右径 (CD)并计算两者间 (AB/CD)的比值 ;对两组额、颞叶区行1H MRS检测 ,得到N 乙酰天门冬氨酸 (N acetylaspartate ,NAA)峰、肌酸 (creatine ,Cr)峰、胆碱 (choline ,Cho)峰的积分值及计算NAA/Cr、NAA/ (Cr Cho)。对 2组检测值 ( x±s)行t检验。结果　AD组的AB =(2 7 5 3± 2 1)mm ,AB/CD =(0 2 2± 0 0 5 )mm及额、颞叶的NAA分别是 32 74± 4 72和35 38± 3 5 2 ,颞叶的NAA/Cr=2 4 6± 0 4 3,与正常对照组比较均有统计学差异 (P <0 0 5 )。用ROC法找出诊断阈值并联合应用诊断早期AD ,敏感性为 87% ,特异性为 94 %。结论　海马回钩间距及其与同层颅腔左右径比值的增大 ;额、颞叶NAA的减少 ,尤其是颞叶NAA的减少有助于对轻度AD患者的早期诊断。     

脑卒中后抑郁患者前额叶磁共振氢质子波谱分析

目的 探讨脑卒中后抑郁患者前额叶氢质子磁共振波谱（1H-MRS）的特点.方法 以31例卒中后抑郁患者为研究组,以30例脑卒中患者为病例对照组,以30例健康志愿者为正常对照组.3组在入组24 h内采用多体素1H-MRS检测双侧前额叶各生化代谢物的变化并进行数据处理.结果 研究组左右侧前额叶NAA/Cr值均低于病例对照组和正常对照组,差异均有统计学意义（均P＜0.05）;研究组左侧前额叶Cho/Cr值显著高于正常对照组,差异具有统计学意义（P＜0.05）;研究组双侧前额叶NAA/Cr值与HAMD评分呈显著性负相关（均P＜0.05）,而双侧前额叶Cho/Cr值与HAMD评分不存在相关关系（P＞0.05）.结论 前额叶神经元代谢的异常可能是卒中后抑郁的神经生物学基础.     

初发抑郁症患者丘脑质子磁共振波谱分析

目的探讨未用药首发抑郁症患者丘脑的脑代谢有无异常。方法利用质子磁共振波谱分析技术(1H-MRS)检测20例未用药首发抑郁症患者和20名健康志愿者丘脑的多个代谢指标,包括乙酰天门冬氨酸盐(NAA)、谷氨酰胺和谷氨酸复合物(Glx)、胆碱复合物(Cho)、肌酸-磷酸肌酸复合物(Cr)等。结果与对照组相比,患者组双侧丘脑NAA/Cr下降,但只有右侧的差异有统计学意义(t=2.923,P<0.05);两组间各代谢值、Cho/Cr和Glx/Cr的差异无统计学意义(P>0.05);轻度抑郁组和重度抑郁组间比较,各代谢值的差异均无统计学意义(P>0.05)。结论初发抑郁症患者右侧丘脑可能存在神经元受损和线粒体代谢障碍。     

难治性抑郁症患者海马代谢的磁共振质子波谱研究

目的 探讨难治性抑郁症患者双侧海马磁共振质子波谱(1H-MRS)的代谢特点.方法 运用1H-MRS成像系统检测16例难治性抑郁症患者(患者组)和16名健康对照者(对照组)双侧海马的N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌醇(mI)及肌酸(Cr)4种代谢产物,分别计算双侧NAA/Cr、Cho/Cr及mI/Cr.采用配对t检验、独立样本t检验及偏相关分析进行统计处理.结果 对照组左侧海马NAA/Cr(1.43±0.19),明显高于右侧(1.21±0.10),P＜0.01.患者组双侧海马NAA/Cr的差异无统计学意义(P＞0.05),右侧海马NAA/Cr(1.44±0.31),明显高于对照组(1.21±0.10),P＜0.01.未发现患者组海马的任何代谢指标与病程及汉密尔顿抑郁量表(17项)评分的相关性(P＞0.05).结论 难治性抑郁症患者右侧海马代谢增强,双侧海马NAA/Cr不对称性消失.     

丙戊酸钠合并氟哌啶醇治疗难治性Tourette综合征

目的 探讨丙戊酸钠合并氟哌啶醇治疗难治性Tourette综合征(TS)的临床疗效和安全性.方法 将93例难治性TS患儿按病例编号分为试验组(58例)和对照组(35例).试验组予丙戊酸钠(400～600 mg/d或15 mg·kg-1·d-1)合并氟哌啶醇(2～6 mg/d)治疗,对照组采取常规治疗[单一或联合使用氟哌啶醇(6～16 mg/d)、泰必利(400～600 m/d)、可乐定(0.15～0.6 mg/d)、安定类药物],共治疗8周.采用YGTSS、国际TS临床信息调查表、儿童行为量表(CBCL)及副反应量表,于治疗前、治疗后第1,3,8周末对两组进行评估.结果 治疗第8周末,试验组的有效率为93%,高于对照组(80%;Z=-4.310,P<0.001);试验组YGTSS总分[(3.50±4.59)分]低于对照组[(7.86±7.03)分;P<0.01],减分率[(83.11±15.13)%]高于对照组[(63.81±27.87)%;P<0.01];试验组的CBCL评分[(11.43±5.27)分]低于对照组[(14.77±6.75)分;t=-2.139,P<0.05];治疗第1周末两组副反应差异无显著性(P>0.05);从第3周末开始试验组副反应评分[(9.26±3.15)分]低于对照组[(11.69±5.51)分;P<0.01],并持续至第8周末.结论 丙戊酸钠合并氟哌啶醇治疗难治性TS,疗效肯定,副反应相对较轻.     

无痴呆型血管性认知障碍患者多体素质子磁共振波谱的诊断价值

目的 探讨多体素质子磁共振波谱(1H-MRS)在无痴呆型血管性认知障碍(VCIND)早期诊断中的价值.方法 入选2008年12月至2009年9月本院门诊及住院患者共78例,完成成套神经心理学测验,包括北京版蒙特利尔认知量表(MoCA)、听觉词语学习测验(AVLT)、数字广度测验(DST)、Rey-Osterrieth复杂图形测验(CFT)、语义与语音流畅试验、数字符号编码测验(DSCT)、连线测验(TMT)、画钟测验(CDT)和Stroop色词测验(SCWT).根据测验成绩分为VCIND组和认知正常对照组,从中选择性别、年龄、文化程度匹配者各18例,利用多体素1H-MRS检测双侧额、颞、顶叶及丘脑灰质区N-乙酰天冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)水平,比较两组间NAA/Cr、Cho/Cr比值的差别;同时,对VCIND组患者MoCA总分及其有认知损害的子项评分与NAA/Cr、Cho/Cr比值进行相关分析.所有入选对象对试验方案均知情同意,本试验通过伦理委员会批准.结果 VCIND组患者左、右两侧丘脑灰质区NAA/Cr比值与对照组比较均明显下降(左侧1.56±0.49、1.89±0.48,F=11.222,P=0.002;右侧1.63±0.45、1.86±0.33,F=5.358,P=0.027);两组间额、颞、顶叶NAA/Cr比值以及所有区域Cho/Cr比值均无统计学意义.VCIND组患者左、右两侧NAA/Cr下降程度与MoCA评分(r=0.54、0.44)及记忆力(r=0.61、0.49)、注意力(r=0.43、0.36)、语言功能(r=0.39、0.31)、视空间与执行能力(r=0.29、0.33)等子项评分均呈正相关(均P＜0.05或P＜0.01).结论 VCIND患者认知功能损害可能与双侧丘脑神经元代谢异常有关,多体素1H-MRS在VCIND早期诊断和病情进展监测中起着重要的作用.     

Aberrant basal ganglia metabolism in fragile X syndrome: a magnetic resonance spectroscopy study

Background

The profile of cognitive and behavioral variation observed in individuals with fragile X syndrome (FXS), the most common known cause of inherited intellectual impairment, suggests aberrant functioning of specific brain systems. Research investigating animal models of FXS, characterized by limited or lack of fragile X mental retardation protein, (FMRP), has linked brain dysfunction to deficits in the cholinergic and glutamatergic systems. Thus, we sought to examine in vivo levels of neurometabolites related to cholinergic and glutamatergic functioning in males and females with FXS.

Methods

The study participants included 18 adolescents and young adults with FXS, and a comparison group of 18 individuals without FXS matched for age, sex and general intellectual functioning. Proton magnetic resonance spectroscopy (MRS) was used to assess neurometabolite levels in the caudate nucleus, a region known to be greatly enlarged and involved in abnormal brain circuitry in individuals with FXS. A general linear model framework was used to compare group differences in metabolite concentration.

Results

We observed a decrease in choline (P = 0.027) and in glutamate + glutamine (P = 0.032) in the caudate nucleus of individuals with FXS, relative to individuals in the comparison group.

Conclusions

This study provides evidence of metabolite differences in the caudate nucleus, a brain region of potential importance to our understanding of the neural deficits underlying FXS. These metabolic differences may be related to aberrant receptor signaling seen in animal models. Furthermore, identification of the specific neurometabolites involved in FXS dysfunction could provide critical biomarkers for the design and efficacy tracking of disease-specific pharmacological treatments.     

Long-term brain metabolic alterations in exogenous Cushing’s syndrome as monitored by proton magnetic resonance spectroscopy

The effects of exogenous Cushing’s syndrome on the brain metabolism were investigated by proton magnetic resonance spectroscopy (MRS). Thirteen patients having been treated for 2 to 22 years with prednisone were recruited. On the average, none of the metabolites (NAA, Cr, Cho and mI) were significantly different from those of 40 normal subjects in any of the three regions studied: frontal area, thalamus and temporal area. However, the Cho/H₂O ratios were found to decrease significantly in the thalamic area as a function of treatment period (−1.3%/year). In the frontal and temporal areas, decreases of the Cho/H₂O ratios were measured with treatment period but they did not reach statistical significance. Effects on Cho levels can be related to those observed for patients with endogenous Cushing’s syndrome and suggest an impairment at the membrane level. The Cho/H₂O reductions were not found to be dose- or age-dependent. Other metabolite ratios did not vary with treatment period, dose or age.     

605例抽动-秽语综合征患者临床分析

目的探讨抽动-秽语综合征(GillesdelaTourette’ssyndrome,TS)的临床特点。方法对1983年2月～2001年5月诊治的605例抽动-秽语综合征患者的临床资料进行总结和分析,并对其中500例进行随访调查。结果605例患者的平均发病年龄为7.7岁,男女之比4∶1;病程1～30年;其中102例(16.9%)有抽动症家族史;172例(28.4%)患者伴有性格行为问题;62.9%(112/178)的患者脑电图存在异常波形。CT检查显示,抽动-秽语综合征患者可有轻微异常(7/67例),但检出率较低;SPECT检查表明,患者额、颞、顶叶等处存在脑血流灌注减低现象(5/5例)。病程与患者发病年龄呈负相关(r=-0.191,P<0.01),与秽语发生年龄呈正相关(r=0.189,P<0.05)。结论抽动-秽语综合征多于儿童期发病,男性较女性多见;具有遗传倾向;可能存在轻微脑功能异常;发病年龄与秽语出现年龄对病程有一定的影响。     

The value of magnetic resonance imaging in carpal tunnel syndrome

We examined 62 patients (72 hands) with carpal tunnel syndrome (CTS) by magnetic resonance imaging (MRI) of the carpal tunnel and latency measurements of the median nerve. In 32 of 72 hands a probable causative lesion of the CTS was identified by MRI, for example tenosynovitis, a cyst-like structure, or an aberrant muscle. The MRI findings were confirmed by surgery in 16 of 24 hands, slightly corrected in 5, and not substantiated in 3. In 65 of 72 hands, MRI disclosed pathology of the median nerve, most prominently an enlargement of the nerve at the level of the os pisiforme, a finding not seen during surgery. Oedema of the nerve was found in 14 of 72 hands. The distal latencies were prolonged in 62 of 72 hands. The sensory latencies correlated significantly with the MRI-determined cross-sectional area of the nerve at the level of the distal radius. The lack of other correlations suggests that partly independent features of the nerve lesion are demonstrated in each method or that the sensitivity and specificity of both methods are limited. Further experience with MRI in CTS is desirable. At present, the practical use of MRI in CTS should be restricted to special diagnostic problems such as carpal tunnel syndromes which do not respond adequately to conservative or surgical treatment.     

MR spectroscopy of the brain in Leigh syndrome

Brain magnetic resonance spectroscopy in two patients with Leigh syndrome revealed the presence of lactate in gray and white matter brain tissue and relatively high choline levels in the white matter. The latter observation, most probably related to an ongoing demyelination process, underlines specific involvement of white matter metabolism in Leigh syndrome even in cases without involvement of the white matter as visualized on MRI. Magnetic resonance spectroscopy might thus be of help in differentiating Leigh syndrome from a range of other mitochondrial diseases, such as ophthalmoplegia and Kearns-Sayre syndrome, showing lack of lactate in brain tissues appearing normal on MRI.