急性大脑中动脉供血区脑梗死与同型半胱氨酸、氢质子磁共振波谱的相关性研究
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摘要
【目的】
研究脑梗死患者血清同型半胱氨酸(Hcy)、氢质子磁共振波谱(1H-MRS)与脑梗死的关系及二者间的相互关系。探讨Hcy及1H-MRS在判定脑梗死患者功能障碍及预后中的价值,以利于在脑梗死早期对其严重程度及预后作出确切的判断,制定合理的治疗方案。
【方法】
对30例发病时间在3天以内,并经头部MRI检查证实诊断的脑梗死(大脑中动脉供血区)患者,在入院后24h内测定静脉血Hcy水平,根据Hcy水平,分为正常组(≤15umol/L)4例,轻度升高组(15～20umol/L)8例,中度升高组(20～25 umol/L)10例,重度升高组(>25umol/L)8例;同时对所有患者病灶中心区及对侧镜像正常脑组织行1H-MRS分析,主要检测物化学位移定位,N-乙酞天门冬氨酸(NAA)2.0ppm、乳酸(Lac)1.32ppm。应用美国国立卫生研究院卒中量表(NIHSS)在患者入院及治疗后3个月时进行神经功能缺损程度评分,分别记作NIHSS1、NIHSS2。对患者的Hcy、NIHSS1、NIHSS2及1H-MRS代谢物的值进行相关性分析。
【结果】
1、1H-MRS在脑梗死中的变化:⑴除2例患者外,28例患者的梗死灶中均可见到不同程度增高的Lac峰;对侧镜像区3例患者出现轻微升高的Lac峰,其余27名患者未见到Lac峰。⑵除1例患者外,29例患者梗死灶中心NAA峰较对侧镜像区均有不同程度的下降,配对样本t检验证实病灶侧NAA低于对侧镜像区有统计学意义(P<0.001)。
2、脑梗死患者中Hcy升高者占86.7%,且Hcy水平越高,1H-MRS中NAA值越低, NAA值的各组间两两比较差异均有统计学意义(P<0.001)。
3、对各指标的相关分析得出:⑴Hcy与NIHSS1、NIHSS2呈正相关关系(r=0.880 P<0.01;r=0.924 P<0.01)。⑵梗死灶中心的NAA与NIHSS1、NIHSS2呈负相关关系(r=-0.842 P<0.01;r=-0.818 P<0.01)。⑶梗死灶中心的Lac与NIHSS1、NIHSS2呈正相关关系(r=0.776 P<0.01;r=0.796 P<0.01)。⑷Hcy与NAA病侧呈负相关关系(r=-0.748 P<0.01)。
【结论】
Hcy与1H-MRS中的NAA、Lac均可对脑梗死病情及预后作出判断,且二者之间具有统计学相关性。
[Objective]
The purpose of our research is first, to study the relation between Homocysteine and Proton magnetic reasonance spectroscopy,then the correlation between them and Cerebral infarction. Second,to detect all the index of 1H-MRS and Hcy in acute cerebral infarction patients, and concentrate on the relation between the changes of the index and the prognosis of the patience, so as to evaluate the application value of 1H-MRS and Hcy in cerebral infarction.
[Methods]
Thirty patients presenting within 3 days of the onset and diagnosed as the cerebral infarction by the brain MRI inspection, were studied. Each patient's Hcy level in the venous blood is assayed. According to the Hcy level, these patients were classified into four groups: the normal group(≤15umol/L), including 4 cases, the mildly increased group(15～20umol/L), including 8 cases, the moderately increased group(20～25umol/L), including 10 cases and the seriously increased group(≥25umol/L), including 8 cases. Meanwhile, we did the 1H-MRS analysis on the infarction area and the opposite normal brain tissue and mainly detected the chemical shift position and the level of NAA (2.0ppm) and Lac (1.32ppm). All the patients’NIHSS scores were determined when they were on admission or treated after three months, and these two scores were noted as NIHSS1、NIHSS2, respectively. At last, we did the correlation analysis to the value of Hcy、NIHSS1、NIHSS2 and 1H-MRS, and drew the conclusion.
[Results]
(1)Changes of 1H-MRS in cerebral infarction: (1) in the infarction area, increased Lactic acid peak in varying degrees was detected in all the patients except two cases; in the mirror imaging normal area, the Lactic acid peak was seemed to mildly increase in only three cases, and the other 27 cases were not. (2) The NAA peak in the center of the infarct area showed deceases in varying degrees compared to the opposite mirror image area on the other 29 cases, except one case, and this resut was confirmed by compared t test with significance(P<0.01).
2. Increased Hcy in varying degrees can be seen in 86.7% of the cerebral infarction patients and the higher the Hcy is, the lower the NAA level of 1H-MRS is. And the accumulated NAA level in the various groups was significant different.
3.Correlative analysis of metabolism changes in infarct center and NIHSS score, NIHSS prognosis showed that :(1)the vary of Hcy in infarct center had positive correlation with NIHSS1、NIHSS2(r=0.880 P<0.01;r=0.924 P<0.01). (2) the vary of NAA in the infarct center has obvious negative correlation with NIHSS1 and NIHSS2(r=-0.842 P<0.01;r=-0.818 P<0.01).⑶the vary of Lac has positive correlation with NIHSS1、NIHSS2 (r=0.776 P<0.01;r=0.796 P<0.01).(4) the vary of NAA in the infarct center has obvious negative correlation with Hcy(r=-0.748 P<0.01).
[Conclusions]
The level of Hcy and NAA、Lac in 1H-MRS all could contribute to the judgement of severity and prognosis of the cerebral infarction patients and there is significant correlation between them.
研究脑梗死患者血清同型半胱氨酸(Hcy)、氢质子磁共振波谱(1H-MRS)与脑梗死的关系及二者间的相互关系。探讨Hcy及1H-MRS在判定脑梗死患者功能障碍及预后中的价值,以利于在脑梗死早期对其严重程度及预后作出确切的判断,制定合理的治疗方案。
【方法】
对30例发病时间在3天以内,并经头部MRI检查证实诊断的脑梗死(大脑中动脉供血区)患者,在入院后24h内测定静脉血Hcy水平,根据Hcy水平,分为正常组(≤15umol/L)4例,轻度升高组(15～20umol/L)8例,中度升高组(20～25 umol/L)10例,重度升高组(>25umol/L)8例;同时对所有患者病灶中心区及对侧镜像正常脑组织行1H-MRS分析,主要检测物化学位移定位,N-乙酞天门冬氨酸(NAA)2.0ppm、乳酸(Lac)1.32ppm。应用美国国立卫生研究院卒中量表(NIHSS)在患者入院及治疗后3个月时进行神经功能缺损程度评分,分别记作NIHSS1、NIHSS2。对患者的Hcy、NIHSS1、NIHSS2及1H-MRS代谢物的值进行相关性分析。
【结果】
1、1H-MRS在脑梗死中的变化:⑴除2例患者外,28例患者的梗死灶中均可见到不同程度增高的Lac峰;对侧镜像区3例患者出现轻微升高的Lac峰,其余27名患者未见到Lac峰。⑵除1例患者外,29例患者梗死灶中心NAA峰较对侧镜像区均有不同程度的下降,配对样本t检验证实病灶侧NAA低于对侧镜像区有统计学意义(P<0.001)。
2、脑梗死患者中Hcy升高者占86.7%,且Hcy水平越高,1H-MRS中NAA值越低, NAA值的各组间两两比较差异均有统计学意义(P<0.001)。
3、对各指标的相关分析得出:⑴Hcy与NIHSS1、NIHSS2呈正相关关系(r=0.880 P<0.01;r=0.924 P<0.01)。⑵梗死灶中心的NAA与NIHSS1、NIHSS2呈负相关关系(r=-0.842 P<0.01;r=-0.818 P<0.01)。⑶梗死灶中心的Lac与NIHSS1、NIHSS2呈正相关关系(r=0.776 P<0.01;r=0.796 P<0.01)。⑷Hcy与NAA病侧呈负相关关系(r=-0.748 P<0.01)。
【结论】
Hcy与1H-MRS中的NAA、Lac均可对脑梗死病情及预后作出判断,且二者之间具有统计学相关性。
[Objective]
The purpose of our research is first, to study the relation between Homocysteine and Proton magnetic reasonance spectroscopy,then the correlation between them and Cerebral infarction. Second,to detect all the index of 1H-MRS and Hcy in acute cerebral infarction patients, and concentrate on the relation between the changes of the index and the prognosis of the patience, so as to evaluate the application value of 1H-MRS and Hcy in cerebral infarction.
[Methods]
Thirty patients presenting within 3 days of the onset and diagnosed as the cerebral infarction by the brain MRI inspection, were studied. Each patient's Hcy level in the venous blood is assayed. According to the Hcy level, these patients were classified into four groups: the normal group(≤15umol/L), including 4 cases, the mildly increased group(15～20umol/L), including 8 cases, the moderately increased group(20～25umol/L), including 10 cases and the seriously increased group(≥25umol/L), including 8 cases. Meanwhile, we did the 1H-MRS analysis on the infarction area and the opposite normal brain tissue and mainly detected the chemical shift position and the level of NAA (2.0ppm) and Lac (1.32ppm). All the patients’NIHSS scores were determined when they were on admission or treated after three months, and these two scores were noted as NIHSS1、NIHSS2, respectively. At last, we did the correlation analysis to the value of Hcy、NIHSS1、NIHSS2 and 1H-MRS, and drew the conclusion.
[Results]
(1)Changes of 1H-MRS in cerebral infarction: (1) in the infarction area, increased Lactic acid peak in varying degrees was detected in all the patients except two cases; in the mirror imaging normal area, the Lactic acid peak was seemed to mildly increase in only three cases, and the other 27 cases were not. (2) The NAA peak in the center of the infarct area showed deceases in varying degrees compared to the opposite mirror image area on the other 29 cases, except one case, and this resut was confirmed by compared t test with significance(P<0.01).
2. Increased Hcy in varying degrees can be seen in 86.7% of the cerebral infarction patients and the higher the Hcy is, the lower the NAA level of 1H-MRS is. And the accumulated NAA level in the various groups was significant different.
3.Correlative analysis of metabolism changes in infarct center and NIHSS score, NIHSS prognosis showed that :(1)the vary of Hcy in infarct center had positive correlation with NIHSS1、NIHSS2(r=0.880 P<0.01;r=0.924 P<0.01). (2) the vary of NAA in the infarct center has obvious negative correlation with NIHSS1 and NIHSS2(r=-0.842 P<0.01;r=-0.818 P<0.01).⑶the vary of Lac has positive correlation with NIHSS1、NIHSS2 (r=0.776 P<0.01;r=0.796 P<0.01).(4) the vary of NAA in the infarct center has obvious negative correlation with Hcy(r=-0.748 P<0.01).
[Conclusions]
The level of Hcy and NAA、Lac in 1H-MRS all could contribute to the judgement of severity and prognosis of the cerebral infarction patients and there is significant correlation between them.
引文
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[3]Bakrer PB,Gillard JH,vna Zijl PCM,et al.Acute Stroke:evaluation with serial proton MR spectroscopie imaging.Radiology1994,192:723一732
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[5]Grhama GD,Kalvoah P,Blamire AM,et al.Clinical correlates of proton magnetic resonance spectroscopy findings after acute cerebral inarfetion.stroke1995,26(2):225一9
[6]Perry TT,Refsum H,Morris RN,et al.Prosrtctive study of serum total homocysteine concentration and risk of stroke in middle-age British men〔J〕.Lancel,1995,346:1395～1398
[7]Kittner SJ,Giles WH,Macko RF,et al.Homocysteine and risk of cerebral infarction in a biralial population:the stroke prevention in young wmoma study〔J〕.Stroke,1999,30:1554～1560
[8]中华神经科学会,中华神经外科学会.各类脑血管疾病诊要点.中华神经科杂志1996,29:379一380.
[9]Audebert HJ,Rott MM ,Eek T,et al.Systemie inflammatory response depends on initial stroke severity but is attenuated by sueeessful thrombolysis.Srtoke2004,35(9):2128一33
[10]王维治主编.神经病学.第5版.北京:人民卫生出版社,2004,126
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