丙戊酸钠治疗双相情感障碍患者在体质子MR频谱分析

目的情绪稳定剂治疗双向情感障碍患者的细胞和分子基础尚未被充分阐明,文献中人体磁共振频谱的研究结果不一致,本研究旨在定量测定双向情感障碍患者服用丙戊酸钠后脑代谢物在额叶和颞叶中的浓度,确定与对照组之间是否存在差异。方法对9名双相情感障碍的成年患者(稳定期)和11名健康志愿者进行检查,应用PRESS序列获得质子磁共振频谱分析数据。正方形体素的大小为2×2×2 cm3,分别定位于额叶皮质、颞叶皮质和体外标准溶液。采用Marquardt方程拟合NAA、总肌酸、胆碱和肌醇的波峰,使用PERCH软件对各波峰面积进行测量,定量测定脑代谢物浓度。结果与健康志愿者相比,患者肌醇浓度并无统计学意义的降低(额叶P=0.79,颞叶P=0.94)。2组受试者的胆碱、总肌酸和NAA的差异亦无统计学意义。患者与健康志愿者的频谱相似。结论服用丙戊酸钠未明显改变稳定期双相情感障碍患者的脑内肌醇浓度。单磷酸肌醇、甘氨酸和大分子的信号可影响所测肌醇浓度的准确性。

No Significant Change in Brain Myo-inositol Is Observed in Bipolar Affective Disorder after Sodium Valproate Medication: in Vivo Proton MR Spectroscopic Analysis

Objective To quantitatively measure the concentrations of metabolites in both frontal and temporal lobes after sodium valproate medication in bipolar patients to determine if these were altered in any way from controls.Methods We studied 9 adult patients with bipolar disorder and 11 healthy volunteers as controls.All the patients took sodium valproate 1 000 mg daily as the sole medication.MR was performed by using a Magnex 3 T scanner and a 1.5T MR scanner.The PRESS sequence was used to acquire proton MRS data with TE1=25 msec,TE2=25 msec,TR=3 000 msec,and 128 scan averages.The MRS data were acquired from three square voxels(2×2×2 cm³) placed in the cortex of frontal lobe,the cortex of temporal lobe,and external standard solution.By measuring T1 and T2 values of the metabolites in the brain and standard solution,accurate brain metabolite concentrations were obtained.Results Similar spectra were found among healthy volunteers and the patients with bipolar disorder.Compared with the concentration of myo-inositol in volunteers,the patients had no significantly lower levels of myo-inositol(P=0.79 in frontal lobe and P=0.94 in temporal lobe,onewey ANOVA).Also,there were no significant differences for choline,total creatine and NAA between volunteer and patient groups.Conclusion Sodium valproate administration does not significantly alter baseline concentrations of myo-inositol in euthymic bipolar patients.It is also possible that there is a limitation for in vivo MRS PRESS sequence to detect the changes in myo-inositol concentration even if there is any change.