CAJ | 학술논문

目的探讨氢质子磁共振波谱(1H-MRS)技术在伴有白质损害(WMLs)的阿尔茨海默病(AD)与血管性痴呆(VD)鉴别诊断中的应用价值.方法对30例伴有WMLs的AD患者、30例VD患者及30例年龄匹配健康对照者(NC)行多体素1 H-MRS检查,测定受检者左侧脑室体旁白质区N-乙酰基天门冬氨酸(NAA)、肌醇(mI)、谷氨酸(Glu)及肌酸(Cr)的峰下面积,单因素方差分析比较各组间NAA/Cr、mI/Cr及Glu/Cr比值的变化.结果在左侧脑室体旁白质区,1H-MRS检查显示AD组和VD组患者NAA/Cr比值分别为(1.59±0.15)及(1.53±0.12),Glu/Cr比值分别为(0.41 ±0.03)及(0.49±0.04),均较NC组(1.79±0.22及0.57±0.05)明显降低,差异有统计学意义(P＜0.05);但AD组和VD组患者之间NAA/Cr比值差异无统计学意义(P＞0.05),而两者Glu/Cr比值差异有统计学意义(P＜0.05).AD组mI/Cr比值为0.68±0.05,较VD组(0.57±0.04)和NC组(0.55±0.03)明显升高,差异均有统计学意义(P＜0.05),而VD组mI/Cr比值较NC组差异无统计学意义(P＞0.05).结论 1H-MRS是鉴别AD与VD的有效方法之一,侧脑室体旁白质区Glu及mI的变化可能是伴有WMLs的AD患者区别于VD患者的特征性代谢变化.
목적 탐토경질자자공진파보(1H-MRS)기술재반유백질손해(WMLs)적아이자해묵병(AD)여혈관성치태(VD)감별진단중적응용개치.방법 대30례반유WMLs적AD환자、30례VD환자급30례년령필배건강대조자(NC)행다체소1 H-MRS검사,측정수검자좌측뇌실체방백질구N-을선기천문동안산(NAA)、기순(mI)、곡안산(Glu)급기산(Cr)적봉하면적,단인소방차분석비교각조간NAA/Cr、mI/Cr급Glu/Cr비치적변화.결과 재좌측뇌실체방백질구,1H-MRS검사현시AD조화VD조환자NAA/Cr비치분별위(1.59±0.15)급(1.53±0.12),Glu/Cr비치분별위(0.41 ±0.03)급(0.49±0.04),균교NC조(1.79±0.22급0.57±0.05)명현강저,차이유통계학의의(P＜0.05);단AD조화VD조환자지간NAA/Cr비치차이무통계학의의(P＞0.05),이량자Glu/Cr비치차이유통계학의의(P＜0.05).AD조mI/Cr비치위0.68±0.05,교VD조(0.57±0.04)화NC조(0.55±0.03)명현승고,차이균유통계학의의(P＜0.05),이VD조mI/Cr비치교NC조차이무통계학의의(P＞0.05).결론 1H-MRS시감별AD여VD적유효방법지일,측뇌실체방백질구Glu급mI적변화가능시반유WMLs적AD환자구별우VD환자적특정성대사변화.
Objective To evaluate the value of proton magnetic resonance spectrum (1H-MRS) in the differential diagnosis of Alzheimer's disease (AD) and vascular dementia (VD) patients with white matter lesions (WMLs).Methods Multi voxel 1H-MRS were performed to 30 patients with AD,30 patients with VD,and 30 normal control volunteers.The levels of the N-acetylaspartate (NAA),myo-inositol (mI),glutamate (Glu),and creatine (Cr) were measured in the white matter adjacent to the lateral ventricles.The ratios of NAA/Cr,mI/Cr and Glu/Cr were calculated and compared among the group.Comparisons of the 1H-MRS indexes among AD,VD and NC group were conducted by one-way ANOVA.Results NAA/Cr ratios of the region of interesting in AD (1.59±0.15)and VD(1.53±0.12) group were significantly decreased compared with NC (1.79±0.22)group (P＜0.05),and Glu/Cr ratios of the region of interesting in AD(0.41±0.03) and VD(0.49±0.04) group were significantly decreased compared with NC(0.57±0.05) group (P＜0.05).However,there were not significant differences for NAA/Cr ratios of the paraventricular white matter region between AD and VD group (P＞0.05),and Glu/Cr ratios in AD and VD groups were significantly different (P＜0.05).A significantly increased mI/Cr was found in AD (0.68±0.05) group than in VD(0.57±0.04) and NC(0.55±0.03) groups (P＜0.05),and there were no significant changes in mI/Cr ratios between VD and NC groups (P＞0.05).Conciusion Multi-voxel 1H-MRS is an effective method in the differential diagnosis of dementia,and changes of the mI/Cr and Glu/Cr ratios of the white matter adjacent to the lateral ventricles may help to identify the AD and VD patients.