中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2008年
1期
8-11
,共4页
王惠芳%樊东升%郎宁%张俊%康德瑄%王力平%刘小璇%傅瑜%张远锦%韩鸿宾
王惠芳%樊東升%郎寧%張俊%康德瑄%王力平%劉小璇%傅瑜%張遠錦%韓鴻賓
왕혜방%번동승%랑저%장준%강덕선%왕력평%류소선%부유%장원금%한홍빈
肌萎缩侧索硬化%磁共振波谱学%大脑皮质
肌萎縮側索硬化%磁共振波譜學%大腦皮質
기위축측색경화%자공진파보학%대뇌피질
Amyotrophic lateral sclerosis%Magnetic resonance spectroscopy%Cerebral cortex
目的 以质子磁共振波谱(1H-MRS)研究肌萎缩侧索硬化(ALS)的上运动神经元病损情况,以期探寻一种评估病情和疾病进程的指标.方法 对110例ALS和24例下运动神经元综合征(LMNS)患者以及89名健康志愿者进行双侧中央前回单体素1H-MRS检查.以上运动神经元受损体征和反射评分、ALS功能评估量表(ALS-FRS)和APPEL ALS量表(AARS)定量评定患者临床症状和体征.结果 与对照组(1.62±0.18)相比,LMNS患者(1.60±0.17)的NAA/Cr无改变,但ALS患者(1.40±0.25)与两组相比均明显降低(与对照组比较,t=-5.007,P=0.000;与LMNS组比较,t=-2.660,P=0.009);在不同分级的ALS患者中,确诊ALS患者较拟诊ALS者和可能ALS者降低更为明显(与拟诊组比较,t=-2.626,P=0.010;与可能组比较,t=-2.537,P=0.013).结合ALS患者临床表现进一步分析发现,上运动神经元体征明显的患者其NAA/Cr较不明显的患者降低更为明显,差异有统计学意义(t=-2.827,P=0.006),相关分析显示,NAA/Cr与患者的反射评分、ALS-FRS、AARS及其各分项均存在显著相关性(P＜0.05).结论 ALS中央前回1H-MRS检测在一定程度上反映患者上运动神经元受损情况,可作为评估患者病情程度的一项临床指标,但其对该病早期诊断和鉴别诊断的价值有限.
目的 以質子磁共振波譜(1H-MRS)研究肌萎縮側索硬化(ALS)的上運動神經元病損情況,以期探尋一種評估病情和疾病進程的指標.方法 對110例ALS和24例下運動神經元綜閤徵(LMNS)患者以及89名健康誌願者進行雙側中央前迴單體素1H-MRS檢查.以上運動神經元受損體徵和反射評分、ALS功能評估量錶(ALS-FRS)和APPEL ALS量錶(AARS)定量評定患者臨床癥狀和體徵.結果 與對照組(1.62±0.18)相比,LMNS患者(1.60±0.17)的NAA/Cr無改變,但ALS患者(1.40±0.25)與兩組相比均明顯降低(與對照組比較,t=-5.007,P=0.000;與LMNS組比較,t=-2.660,P=0.009);在不同分級的ALS患者中,確診ALS患者較擬診ALS者和可能ALS者降低更為明顯(與擬診組比較,t=-2.626,P=0.010;與可能組比較,t=-2.537,P=0.013).結閤ALS患者臨床錶現進一步分析髮現,上運動神經元體徵明顯的患者其NAA/Cr較不明顯的患者降低更為明顯,差異有統計學意義(t=-2.827,P=0.006),相關分析顯示,NAA/Cr與患者的反射評分、ALS-FRS、AARS及其各分項均存在顯著相關性(P＜0.05).結論 ALS中央前迴1H-MRS檢測在一定程度上反映患者上運動神經元受損情況,可作為評估患者病情程度的一項臨床指標,但其對該病早期診斷和鑒彆診斷的價值有限.
목적 이질자자공진파보(1H-MRS)연구기위축측색경화(ALS)적상운동신경원병손정황,이기탐심일충평고병정화질병진정적지표.방법 대110례ALS화24례하운동신경원종합정(LMNS)환자이급89명건강지원자진행쌍측중앙전회단체소1H-MRS검사.이상운동신경원수손체정화반사평분、ALS공능평고량표(ALS-FRS)화APPEL ALS량표(AARS)정량평정환자림상증상화체정.결과 여대조조(1.62±0.18)상비,LMNS환자(1.60±0.17)적NAA/Cr무개변,단ALS환자(1.40±0.25)여량조상비균명현강저(여대조조비교,t=-5.007,P=0.000;여LMNS조비교,t=-2.660,P=0.009);재불동분급적ALS환자중,학진ALS환자교의진ALS자화가능ALS자강저경위명현(여의진조비교,t=-2.626,P=0.010;여가능조비교,t=-2.537,P=0.013).결합ALS환자림상표현진일보분석발현,상운동신경원체정명현적환자기NAA/Cr교불명현적환자강저경위명현,차이유통계학의의(t=-2.827,P=0.006),상관분석현시,NAA/Cr여환자적반사평분、ALS-FRS、AARS급기각분항균존재현저상관성(P＜0.05).결론 ALS중앙전회1H-MRS검측재일정정도상반영환자상운동신경원수손정황,가작위평고환자병정정도적일항림상지표,단기대해병조기진단화감별진단적개치유한.
Objective To explore the significance of proton magnetic resonance spectroscopy(1H- MRS)in patients with amyotrophic lateral sclerosis(ALS).Methods Single-voxel1 H-MRS was carried on the preeentral gyri in 110 patients with ALS and 24 patients with lower motor neuron syndrome (LMNS) compared with 89 healthy controls.The upper motor neuron involvement of the patients was assessed by upper motor neuron(UMN)signs and the reflex scale,and the disease severity was evaluated by the AIJS function rating scale(ALS-FRS)and APPEL ALS rate scale(AARS).Results Compared with the healthy controls(1.62±0.18),the NAA/Cr of patients with ALS(1.40±0.25)remarkably decreased (t= -5.007,P=0.000),however,it did not change in patients with LMNS(1.60±0.17)as compared with that of the controls.The NAA/Cr of patients with ALS was also lower than that of patients with LMNS(t= -2.660,P=0.009).Furthermore,the NAA/Cr of patients with definite ALS was lower than those of patients with probable and possible ALS(definite vs probable:t=-2.626,P=0.010;definite vs possible: t=-2.537,P=0.013).On the other hand,patients with pronounced UMN signs had a lower NAA/Cr ratio than those with probable UMN signs(t=-2.827,P=0.006).In patients with asymmetric clinical presentation,the NAA/Cr ratio was significantly lower in the precentral gyrus contralateral to the clinically predominantly affected side(t=-2.652,P=0.011).The NAA/Cr was correlated with the reflex scale scores,ALS-FRS score,and AARS and its sub-items(P＜0.05). Conclusions 1H-MRS is useful in studying ALS.The marker NAA/Cr of precentral gyrus may reflect the UMN degeneration in ALS,which is related to the disease severity and progression.However,it might not be helpful in the early diagnosis and differential diagnosis of the disease.
