脑部定量氢磁共振波谱在检测系统性红斑狼疮早期神经元损伤中的敏感性
Sensitivity of quantitative (1)H magnetic resonance spectroscopy of the brain in detecting early neuronal damage in systemic lupus erythematosus.
作者信息
Axford J S, Howe F A, Heron C, Griffiths J R
机构信息
Academic Unit for Musculoskeletal Disease, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
出版信息
Ann Rheum Dis. 2001 Feb;60(2):106-11. doi: 10.1136/ard.60.2.106.
OBJECTIVE
To quantify N-acetylaspartate (NAA), total creatines (tCr), total cholines (tCho), and myo-inositol (mI) levels in normal and abnormal appearing white matter of patients with neuropsychiatric systemic lupus erythematosus (NPSLE) in order to determine the specific changes in metabolite concentrations.
METHODS
Axial proton density and T(2) weighted magnetic resonance images, and short echo time (TE 30 ms) (1)H spectra were acquired with a GE SIGNA 1.5 T magnetic resonance system. Concentrations of NAA, tCr, tCho, and mI were determined, using brain tissue water as a reference, from nine patients (seven female, mean age 40.3 years, range 16-65) with NPSLE and eight healthy women (mean age 43 years, range 31-65).
RESULTS
A significant rise of tCho (12.4%, p<0.05) and mI (31.4%, p<0.005) and a significant reduction in NAA (-12%, p<0.05) was found in normal appearing white matter compared with controls. Analysis according to severity of the clinical NPSLE features (subgrouped as major or minor) showed that SLE major had reduced NAA compared with SLE minor (-18.4%, p<0.05) and controls (-20%, p<0.005). The SLE major group showed a significant rise of mI (32%, p<0.01) and the SLE minor group a significant increase in tCho (18.6%, p<0.05) compared with controls. Longitudinal analysis of brain metabolites in normal appearing white matter showed consistent abnormalities in NAA, tCho, and mI in a patient with stable clinical features and a constant rise of tCho, but transient rise of mI was seen during a flare of disease in another patient.
CONCLUSION
Quantitative (1)H magnetic resonance spectroscopy (MRS) suggests a particular course of neurometabolite changes that precedes irreversible reductions in NAA and permanent neuronal loss. Initially, in patients with SLE minor, there is a significant rise in tCho and a trend (reversible) for mI also to be raised. In patients with SLE major the NAA is significantly and permanently reduced and mI is significantly raised, whereas the tCho levels are near normal. Further investigations are needed to determine how specific MRS is as a clinical marker for brain disturbance in SLE.
目的
对神经精神性系统性红斑狼疮（NPSLE）患者正常及异常表现的白质中N-乙酰天门冬氨酸（NAA）、总肌酸（tCr）、总胆碱（tCho）和肌醇（mI）水平进行定量分析，以确定代谢物浓度的具体变化。
方法
使用GE SIGNA 1.5 T磁共振系统采集轴位质子密度和T2加权磁共振图像以及短回波时间（TE 30 ms）的氢谱。以脑组织水为参照，测定9例（7例女性，平均年龄40.3岁，范围16 - 65岁）NPSLE患者和8例健康女性（平均年龄43岁，范围31 - 65岁）的NAA、tCr、tCho和mI浓度。
结果
与对照组相比，正常表现白质中tCho（升高12.4%，p<0.05）和mI（升高31.4%，p<0.005）显著升高，NAA（降低12%，p<0.05）显著降低。根据临床NPSLE特征的严重程度（分为主要或次要）进行分析显示，与SLE次要组相比，SLE主要组的NAA降低（降低18.4%，p<0.05），与对照组相比降低20%（p<0.005）。与对照组相比，SLE主要组的mI显著升高（升高32%，p<0.01），SLE次要组的tCho显著升高（升高18.6%，p<0.05）。对正常表现白质中脑代谢物进行纵向分析显示，一名临床特征稳定的患者其NAA、tCho和mI持续异常，tCho持续升高，但另一名患者在疾病发作期间mI短暂升高。
结论
定量氢磁共振波谱分析（MRS）提示神经代谢物变化的特定过程，该过程先于NAA不可逆降低和永久性神经元丢失。最初，在SLE次要组患者中，tCho显著升高，mI也有升高趋势（可逆）。在SLE主要组患者中，NAA显著且永久性降低，mI显著升高，而tCho水平接近正常。需要进一步研究以确定MRS作为SLE脑功能障碍临床标志物的特异性。
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