急性一氧化碳中毒迟发脑病的磁共振波谱特征及其临床意义

目的 研究急性一氧化碳中毒迟发脑病(delayed encephalopathy following acute carbon monoxide poisoning,DEACOP)患者的质子磁共振波谱(1H magnetic resonance spectroscopy,1H MRS)特征及临床意义.方法 对38例DEACOP患者和30例正常志愿者分别进行常规核磁及质子磁共振波谱检查,对比分析DEACOP患者与正常志愿者的额叶、脑室旁、枕叶的N-乙酰天门冬氨酸(NAA)、肌酸/磷酸肌酸(Cr)、含胆碱代谢物(Cho)含量的变化,对以Cr为参照的代谢产物比值(Cho/Cr,Cho/NAA,NAA/Cr)进行比较,并分析NAA/Cr、Cho/Cr、Cho/NAA与患者简易智能状态检查量表(MMSE)和患者日常生活能力量表(ADL)的相关性.结果 获取的DEACOP组患者波谱数据显示不同部位的NAA/Cr同对照组比较降低,差异有统计学意义(P＜0.01),Cho/Cr、Cho/NAA同对照组比较增高,差异有统计学意义(P＜0.01);Cho/Cr与MMSE、ADL评分呈明显负相关,Cho/NAA与MMSE、ADL评分呈明显负相关,NAA/Cr与MMSE、ADL评分呈明显正相关.中、重度DEACOP患者NAA/Cr同轻度患者比较降低,差异有统计学意义(P＜0.05),Cho/Cr、Cho/NAA同对照组比较增高,差异有统计学意义(P＜0.05).结论 通过1H MRS检测DEACOP患者脑部病灶的代谢异常可显示神经元损伤程度,代谢物比值异常变化提示预后不佳.

Abstract：

Objective To study the characteristics of proton magnetic resonance spectroscopy (1H magnetic resonance spectroscopy, 1H MRS) in patients with delayed encephalopathy following acute carbon monoxide poisoning (DEACOP) and its significance in the early diagnosis of the disease. Methods MRI and 1H MRS were performed in 38 DEACOP patients and 30 healthy volunteers. The ratios of N-acetylaspartate ( NAA), Creatine ( Cr), Choline (Cho) peaks were measured in each volume of interest, and the correlation of Activity of Daily Living Scale (ADL) and Mini-Mental State Examination (MMSE) with NAA/Cr, Cho/Cr,Cho/NAA were analyzed. Results Compared with those of the control group, the NAA/Cr ratio in different parts decreased with very significant statistical differences ( P ＜ 0. 01 ), while Cho/Cr and Cho/NAA ratio increased also with very significant statistical difference ( P ＜ 0. 01 ). Negative correlation was found in the assessment scores between Cho/Cr and MMSE, ADL. Cho/NAA was also negatively correlated in the assessment scores with MMSE and ADL, and NAA/Cr was positively correlated in the assessment scores with MMSE and ADL. The NAA/Cr ratio in moderate and serious DEACOP patients decreased, when it was compared with that of the mild DEACOP patients, with statistical differences (P ＜ 0. 05 ). Cho/Cr and Cho/NAA ratio increased, when it was compared with that of the control group, with statistical differences ( P ＜0. 05). Conclusions 11 MRS could detect metabolic abnormalities in DEACOP patients with brain lesion.Abnormal changes in the ratio of metabolites might indicate poor prognosis.

Characteristics and significance of 1H magnetic resonance spectroscopy in delayed encephalopathy following acute carbon monoxide poisoning

Objective To study the characteristics of proton magnetic resonance spectroscopy (1H magnetic resonance spectroscopy, 1H MRS) in patients with delayed encephalopathy following acute carbon monoxide poisoning (DEACOP) and its significance in the early diagnosis of the disease. Methods MRI and 1H MRS were performed in 38 DEACOP patients and 30 healthy volunteers. The ratios of N-acetylaspartate ( NAA), Creatine ( Cr), Choline (Cho) peaks were measured in each volume of interest, and the correlation of Activity of Daily Living Scale (ADL) and Mini-Mental State Examination (MMSE) with NAA/Cr, Cho/Cr,Cho/NAA were analyzed. Results Compared with those of the control group, the NAA/Cr ratio in different parts decreased with very significant statistical differences ( P ＜ 0. 01 ), while Cho/Cr and Cho/NAA ratio increased also with very significant statistical difference ( P ＜ 0. 01 ). Negative correlation was found in the assessment scores between Cho/Cr and MMSE, ADL. Cho/NAA was also negatively correlated in the assessment scores with MMSE and ADL, and NAA/Cr was positively correlated in the assessment scores with MMSE and ADL. The NAA/Cr ratio in moderate and serious DEACOP patients decreased, when it was compared with that of the mild DEACOP patients, with statistical differences (P ＜ 0. 05 ). Cho/Cr and Cho/NAA ratio increased, when it was compared with that of the control group, with statistical differences ( P ＜0. 05). Conclusions 11 MRS could detect metabolic abnormalities in DEACOP patients with brain lesion.Abnormal changes in the ratio of metabolites might indicate poor prognosis.