1H-MRS检测儿童及青少年创伤后应激障碍大脑前扣带回代谢物改变

目的 探讨儿童及青少年创伤后应激障碍（PTSD）患者¹H-MRS中大脑前扣带回区代谢物水平的变化。方法 纳入汶川地震幸存者57人，包括10例PTSD患者、23名PTSD康复者和24名健康者。对所有研究对象行¹H-MRS检查，检测大脑前扣带回区N-乙酰天门冬氨酸（NAA）、肌酸（Cr）、胆碱（Cho）、肌醇（MI）和谷氨酸和谷氨酰胺复合物（Glx）水平，计算并比较NAA/Cr、Glx/Cr、Cho/Cr、MI/Cr的差异。结果 Glx/Cr：PTSD患者（1.16±0.15）、PTSD患者+PTSD康复者（1.31±0.07）均明显低于健康者（1.59±0.10），PTSD患者明显低于PTSD康复者+健康者（1.48±0.07），差异均有统计学意义（P均<0.05），PTSD康复者（1.37±0.08）与健康者和PTSD患者间差异均无统计学意义（P均>0.05）。NAA/Cr、Cho/Cr和MI/Cr差异均无统计学意义（P均>0.05）。结论 ¹H-MRS中儿童及青少年PTSD患者大脑前扣带回区Glx明显下降，其改变可能在PTSD病理生理机制中发挥重要作用。

1H-MRS in detection of metabolites changes in anterior cingulate cortex of pediatric and adolescent patients with post traumatic stress disorder

Objective To investigate the changes of metabolites level in anterior cingulate cortex of pediatric and adolescent patients with post traumatic stress disorder (PTSD) using ¹H-MRS. Methods Totally 57 earthquake survivors including 10 PTSD patients, 23 rehabilitative subjects and 24 healthy subjects were enrolled. ¹H-MRS of anterior cingulate cortex was performed in all the subjects. The level of N-acetylaspartate (NAA), Creatine (Cr), Choline (Cho), Glutamate-Glutamine (Glx) and Myo-Inositol (MI) was detected, and the NAA/Cr, Glx/Cr, Cho/Cr, MI/Cr was calculated and compared between different subjects. Results Glx/Cr in PTSD patients (1.16±0.15) and PTSD patients+rehabilitative subjects (1.31±0.07) were both significantly lower than those in healthy subjects (1.59±0.10, both P<0.05). Glx/Cr in PTSD patients was significantly lower than that in rehabilitative subjects+healthy subjects (1.48±0.07, P<0.05). There were no differences of Glx/Cr between rehabilitative subjects (1.37±0.08) and healthy subjects as well as PTSD patients (both P>0.05). No differences were found between the three kinds of subjects for NAA/Cr, Cho/Cr and MI/Cr (all P>0.05). Conclusion In ¹H-MRS, the level of Glx in anterior cingulate cortex reduces significantly in pediatric and adolescent PTSD patients, which may play an important role in pathogenesis of PTSD.