本文選題：輕度認知功能損害 + 阿爾茨海默病��； 參考：《蘇州大學》2013年碩士論文

【摘要】：目的： 利用磁共振波譜分析（MRS）技術對輕度認知障礙（MCI）、阿爾茨海默病（AD）患者及正常老年人雙內(nèi)側(cè)顳葉及海馬區(qū)局部腦代謝變化進行研究，，探討MRS代謝指標與認知功能的關系及其在MCI和AD的診斷價值。 方法： 采用簡易精神狀態(tài)評價量表（MMSE）、臨床癡呆評定量表（CDR）、阿爾茨海默病評價量表-認知分表（ADAS-Cog）等認知量表分別對MCI、AD和正常老年人各12例進行認知功能測試檢查。 應用GE公司生產(chǎn)的3.0T Signa HDxt超導磁共振掃描儀對所有入選的研究對象行常規(guī)MRI掃描，排除腦內(nèi)其他疾��；隨后對腦內(nèi)感興趣區(qū)（雙側(cè)海馬及內(nèi)側(cè)顳葉）的1H-MRS采集。系統(tǒng)自動測出各代謝物濃度，并計算出各自相應的比值包括NAA/Cr，Cho/Cr，mI/Cr及NAA/mI。 應用統(tǒng)計學軟件比較MCI組、AD組和正常對照組各代謝物比值的差異，并將其與認知功能進行相關性分析。 結(jié)果： 1.（1）雙內(nèi)側(cè)顳葉1H-MRS各代謝物比值的變化： MCI組雙內(nèi)側(cè)顳葉NAA/mI明顯低于NC組，差異顯著（P0.05）。AD組左內(nèi)側(cè)顳葉NAA/Cr、NAA/mI均明顯低于NC組，差異顯著（P0.05）；右內(nèi)側(cè)顳葉NAA/mI明顯低于NC組，差異顯著（P0.05），NAA/Cr低于NC組，差異不顯著（P0.05）。AD組與MCI組相比，差異不顯著（P0.05）；余代謝物比值差異不顯著(P0.05)。 （2）海馬區(qū)1H-MRS各代謝物比值的變化： MCI組雙側(cè)海馬NAA/mI明顯均低于NC組，差異顯著(P0.05)；mI/Cr明顯高于NC組，差異顯著(P0.05)。AD組雙側(cè)海馬NAA/Cr、NAA/mI明顯低于NC組，差異顯著（P0.05）。AD組NAA/mI低于MCI組，差異顯著(P0.05)；mI/Cr明顯高于MCI組，差異顯著(P0.05)。余代謝物比值差異不顯著(P0.05)。 2.（1）MMSE評分與1H-MRS的相關性： MCI組MMSE延遲回憶亞項與左內(nèi)側(cè)顳葉NAA/Cr呈正相關（P0.05）；AD組與左側(cè)海馬區(qū)NAA/Cr、NAA/mI呈正相關（P0.05），視空間能力與右側(cè)海馬區(qū)NAA/Cr呈正相關（P0.05）。 （2）ADAS-Cog評分與1H-MRS的相關性： MCI組ADAS-Cog單詞回憶亞項與左內(nèi)側(cè)顳葉NAA/Cr呈負相關（P0.05），mI/Cr呈正相關（P0.05）；AD組與左側(cè)海馬區(qū)NAA/Cr、NAA/mI呈負相關（P0.05）。 結(jié)論: 1. NAA/mI指標的變化早于NAA/Cr的改變，提示NAA/mI能更早地警示MCI的出現(xiàn)，可單獨作為AD早期的診斷依據(jù)。 2. MMSE延遲回憶亞項的評分與左內(nèi)側(cè)顳葉NAA/Cr的相關性最為明顯，提示認知功能評價MMSE延遲回憶亞項評分與磁共振波譜分析檢查結(jié)合可作為MCI和AD早期診斷及鑒別診斷的重要工具，也可作為監(jiān)測MCI病情進展的重要指標。
[Abstract]:Objective: to study the changes of regional brain metabolism in patients with mild cognitive impairment (MCI), Alzheimer's disease (AD) and the bilateral medial temporal lobe and hippocampus by magnetic resonance spectroscopy (Mrs). To explore the relationship between Mrs metabolism and cognitive function and its diagnostic value in MCI and AD. Methods: MMSE, CDR and ADAS-Cog were used to examine the cognitive function of 12 patients with MCIAD and 12 normal aged people. The 3.0T Signa HDxt superconducting magnetic resonance scanner produced by GE Company was used to scan all the subjects to exclude other diseases in the brain, and then 1H-MRS was collected from the regions of interest (bilateral hippocampus and medial temporal lobe). The system automatically measured the concentrations of each metabolite and calculated their respective ratios, including NAA / Cro / Cr / Cr and NAA / MI. Statistical software was used to compare the ratio of metabolites between AD group and normal control group in MCI group, and the correlation between the ratio of metabolites and cognitive function was analyzed. Results: (1) the ratio of 1H-MRS metabolites in bilateral medial temporal lobes: NAA / mi of bilateral medial temporal lobes in MCI group was significantly lower than that in NC group (P0.05), and the difference was significant (P0.05). NAA / Cr ~ (+) NAA / mi in left medial temporal lobe in AD group was significantly lower than that in NC group (P0.05). NAA / mi in the right medial temporal lobe was significantly lower than that in NC group (P0.05), and the difference was not significant in AD group (P0.05) compared with MCI group (P0.05). There was no significant difference in the ratio of residual metabolites (P0.05). The ratio of 1H-MRS metabolites in hippocampus was significantly lower in MCI group than in NC group, and the difference was significant (P0.05). The difference was significant (P0.05). The NAA / Cr of AD group was significantly lower than that of NC group, the difference was significant (P0.05). The difference between AD group and MCI group was significantly higher than that of MCI group (P0.05), and the difference was significant (P0.05). (1) the correlation between MMSE score and 1H-MRS: MMSE delayed recall subitem in MCI group was positively correlated with NAA / Cr in left medial temporal lobe (P0.05); In AD group, there was a positive correlation between NAA / Cr / NAA / mi in left hippocampal area (P0.05), and there was a positive correlation between visual spatial ability and NAA / Cr in right hippocampus (P0.05). (2). There was a negative correlation between ADAS-Cog word recall subitem and NAA / Cr in left medial temporal lobe (P0.05) in AD group (P0.05), and there was a positive correlation between ADAS-Cog score and NAA / Cr in left medial temporal lobe (P0.05). In AD group, there was a negative correlation between NAA / Cr and NAA / mI in left hippocampal area (P0.05). Conclusion: 1. The change of the index of NAA / mi was earlier than that of NAA / Cr, suggesting that NAA / mi could warn the emergence of MCI earlier and could be used as the basis for the early diagnosis of AD alone. 2. The correlation between the scores of MMSE delayed recall subitems and NAA / Cr in left medial temporal lobe was most significant, which suggested that the combination of cognitive function evaluation with magnetic resonance spectroscopy analysis can be used as an important tool for early diagnosis and differential diagnosis of MCI and AD. It can also be used as an important index to monitor the progression of MCI.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R749.16

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