氢质子磁共振波谱分析对脑卒中后血管性痴呆患者的诊断价值

目的 利用氢质子磁共振波谱分析（1H-MRS）技术研究脑卒中后血管性痴呆（VD）患者颞叶海马区细胞代谢水平及其用于临床诊断的价值.方法 对年龄相匹配的脑卒中后VD患者18例、脑卒中非VD患者13例及来源于门诊就诊者14例正常对照组,行双侧颞叶海马区1H-MRS检测,3组患者双侧颞叶海马区N-乙酰天门冬氨酸盐（NAA）/肌酸（Cr）比值、胆碱复合物（Cho）/Cr比值.结果 脑卒中后VD组患者NAA/C比值较正常对照组及脑卒中非VD组均下降（P＜0.05 或0.01）;而Cho/Cr比值较正常对照组明显升高（P＜0.05 ）,较脑卒中非VD组左侧升高（P＜0.05）,但右侧的差异无统计学意义（P ＞0.05）.脑卒中非VD组NAA/Cr比值及Cho/Cr比值较正常对照组虽有变化,但差异无统计学意义（P ＞0.05）.脑卒中后VD组MMSE评分与双侧颞叶海马区NAA/Cr及Cho/Cr比值有相关性（P＜0.05）,且MMSE分数越低,NAA/Cr比值越低,而Cho/Cr比值越高.结论 利用1H-MRS技术研究脑卒中后VD患者双侧颞叶海马区细胞代谢水平,有助于早期发现脑卒中后VD.

1H-magnetic resonance spectroscopy in diagnosis of vascular dementia after stroke

Objective To investigate the diagnostic value of 1H-magnetic resonance spectroscopy （1H-MRS） for vascular dementia（VD） in stroke patients. Methods Eighteen stroke patients with VD, 13 stroke patients without VD and 14 healthy subjects matched for age were enrolled in the study. 1H-MRS examinations of bilateral hippocampus were conducted in all patients; the N-acetylaspartate（NAA）, choline（ Cho）and creatine（ Cr）were measured and the ratios of NAA/Cr and Cho/Cr were compared among groups. Results The patients with VD had a significantly lower NAA/Cr ratio in bilateral temporal hippocampus regions than normal controls and the stroke patients without VD （P〈0.01 ,P〈0.05}, and had a higher Cho/Cr ratio than normal controls （P〈0.05）. The Cho/Cr ratio of left hippocampus in patients with VD was higher than that in patients without VD（P〈 0.05）, but there was no significantly difference in right hippocampus between two groups （P 〉0.05 ）. There were no significant differences in NAA/Cr ratio and Cho/Cr ratio between patients without VD and normal controls. Relative-regression analysis found that MMSE scores were positively correlated with NAA/Cr and negatively correlated with Cho/Cr in bilateral hippocampus regions in patients with VD. Conclusion The metabolic status of bilateral hippocampus regions examined by 1H-MRS might be of value in early detection of vascular dementia in stroke patients.