代谢综合征患者的脑MR波谱研究

目的应用MR波谱(MRS)检测代谢综合征(MS)患者的脑内代谢物,早期发现亚临床脑细胞损害。材料与方法对病例组(MS患者15例)和对照组(健康体检者17例)评估检查有否肥胖、高血糖、高血压、血脂异常4项指标和神经功能相关量表评分后,行头颅MRS检查,测定扣带回后部、背侧丘脑及侧脑室后角NAA/Cr、Cho/Cr、NAA/Cho的比值,对所测得结果进行统计学分析。结果 (1)病例组及3项指标异常、2项指标异常组NAA/Cr、NAA/Cho在背侧丘脑、扣带回、侧脑室后角都明显低于对照组,差异有显著统计学意义(P值均<0.01),Cho/Cr在扣带回、侧脑室后角明显高于对照组,差异有显著统计学意义(P值均<0.05)。(2)多元回归分析结果显示:①NAA/Cr(背侧丘脑)与血糖呈负相关(r=-0.187,P值<0.05),NAA/Cr(侧脑室后角)与LDL呈负相关(r=-0.179,P值<0.05)。②NAA/Cr(背侧丘脑)与高脂血症年限呈负相关(r=-0.033,P值<0.01);侧脑室后角NAA/Cr与高血压年限、糖尿病年限呈负相关(r值分别为-0.028、-0.029,P值均<0.05)。NAA/Cho(背侧丘脑)与高脂血症年限呈负相关(r=-0.027,P<0.05);(侧脑室后角)与糖尿病年限、肥胖年限呈负相关(r值分别为-0.047、-0.017,P值均<0.05)。结论病程在5年以上的MS患者存在亚临床脑损害。糖尿病、高血压、高血脂、肥胖是脑损害的独立危险因素。脑损害严重程度与MS代谢异常病程明显相关。

Magnetic resonance spectroscopy study of patients with metabolic syndrome

Objective： In order to understand subclinical brain damage in the early stage, we used magnetic resonances spetroscopy （MRS） to detect the metabolic changes in the encephalon in participants with metabolic syndrome （MS）. Materials and Methods： Of the project, 32 participants were categorized into two groups, metabolic syndrome group （15 participants） and control group （17 participants）. We assessed whether they were hyperglycemia, hypertension, hyperlipidemia, obesity and nerves function rating scales, then examed their brain using MRS. The metabolite ratios of NAA/Cr, Cho/Cr and NAA/Cho were measured in the dorsal thalamus, posterior cingulate gyrus and posterior part of lateral ventricle, then statistical analysis was performed. Results： （1） Compared to the control group,significant ratio of NAA/Cr and NAA/Cho declines of the MS patients, with three components of metabolic disorder and with two components of metabolic disorder in MS group in the dorsal thalamus,the posterior cingulate gyrus and posterior part of lateral ventricle were found （P values all 〈0.01）. And significant ratio of Cho/Cr increases in the callosal gyrus and posterior part of lateral ventricle were found （P values all 〈0.05）. （2） The multiple regression results： The ratio of NAA/Cr was negatively associated with blood glucose in the dorsal thalamus （r=-0.187, P value 〈0.05）. The ratio of NAA/Cr was negatively associated with LDL in the posterior part of lateral ventricle （r=-0.179, P value 〈0.05）. Theratio of NAA/Cr was negatively associated with the course of hyperlipidemia in the dorsal thalamus （r=- 0.033, P value 〈0.01）, and negatively associated with the course of hypertension and diabetes mellitus in the posterior part of lateral ventricle （r values to be -0.028, -0.029, P values all 〈0.05）. The ratio of NAA/Cho was negatively associated with the course of hyperlipidemia in the dorsal thalamus （r=-0.027, P value 〈0.05）, and negatively associated with the course of diabetes mellitus and obesity in the posterior part of lateral ventricle （r values to be -0.047, -0.017, P values all 〈0.05）. Conclusions： （1） During this study, it was found that the abnormality of NAA/Cr, NAA/Cho, Cho/Cr suggests the abnormality of brain cells metabolism in the participants with metabolic disorder and MRS can help us to understand subclinical brain damage in the early stage. （2） Diabetes mellitus,hyp ertension,hyperlipidemia and obesity may be the independent risk factors for the metabolic dysfunction of brain cells. （3） There is obvious correlation between the severity of brain damage which shows on MR and the course of metabolism abnormality.