Lee Ha Neul, Yoon Choon-Sik, Lee Young-Mock
Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea.
Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, South Korea.
Front Neurol. 2018 Jul 27;9:621. doi: 10.3389/fneur.2018.00621. eCollection 2018.
Analysis of serum biomarkers and magnetic resonance spectroscopy (MRS) are useful for monitoring disease progression in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). We evaluated the correlation of serum biomarkers and MRS parameters during changes associated with stroke-like episodes. In 13 symptomatic MELAS patients carrying the A3243G mutation, we retrospectively obtained 207 voxels from 41 MRS studies, which were divided into three groups according to the temporal association with stroke-like episodes. The MRS NAA/Cr, Cho/Cr, NAA/Cho ratios, the presence of a lactate peak, serum biomarkers, serum lactate level and the pyruvate (Lac/Pyr) ratio were determined. In regions with acute infarcts, the severity of serum Lac/Pyr and that of the MRS lactate peak ( = 0.0007) correlated; serum lactate ( = 0.02), severity of elevated serum lactate ( = 0.04), and serum Lac/Pyr ( = 0.02) correlated weakly. In previously infarcted regions, the severity of the MRS lactate peak and serum Lac/Pyr ( = 0.03), as well as the severity of serum Lac/Pyr ( = 0.02) were weakly correlated. In structurally normal regions, we found a weak to moderate negative correlation between serum lactate and MRS NAA/Cr ( = 0.008), and between the severity of elevated serum lactate and MRS NAA/Cr ( = 0.002) as well as MRS NAA/Cho ( = 0.02). MRS parameters correlate with specific serum biomarkers, and are useful for monitoring changes in brain metabolites, particularly as related to stroke-like episodes.
血清生物标志物分析和磁共振波谱（MRS）有助于监测线粒体脑肌病伴乳酸酸中毒和卒中样发作（MELAS）患者的疾病进展。我们评估了卒中样发作相关变化期间血清生物标志物与MRS参数的相关性。在13例携带A3243G突变的有症状MELAS患者中，我们回顾性地从41项MRS研究中获取了207个体素，根据与卒中样发作的时间关联将其分为三组。测定了MRS的NAA/Cr、Cho/Cr、NAA/Cho比值、乳酸峰的存在情况、血清生物标志物、血清乳酸水平和丙酮酸（Lac/Pyr）比值。在急性梗死区域，血清Lac/Pyr的严重程度与MRS乳酸峰的严重程度相关（=0.0007）；血清乳酸（=0.02）、血清乳酸升高的严重程度（=0.04）和血清Lac/Pyr（=0.02）呈弱相关。在既往梗死区域，MRS乳酸峰的严重程度与血清Lac/Pyr（=0.03）以及血清Lac/Pyr的严重程度（=0.02）呈弱相关。在结构正常区域，我们发现血清乳酸与MRS NAA/Cr（=0.008）之间、血清乳酸升高的严重程度与MRS NAA/Cr（=0.002）以及MRS NAA/Cho（=0.02）之间存在弱至中度负相关。MRS参数与特定的血清生物标志物相关，有助于监测脑代谢物的变化，特别是与卒中样发作相关的变化。
