Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
Department of Radiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
Neurol Sci. 2021 Oct;42(10):4257-4263. doi: 10.1007/s10072-021-05107-3. Epub 2021 Feb 17.
The diagnosis of amyotrophic lateral sclerosis (ALS) requires both upper and lower motor neuron signs. However, quite a few patients with ALS lack the upper motor neuron sign during the disease. This study sought to investigate whether metabolites, including glutamate (Glu), N-acetyl aspartate (NAA), and gamma aminobutyric acid (GABA), in the supplementary motor area (SMA) measured by magnetic resonance spectroscopy (MRS), could be a surrogate biomarker for ALS. Twenty-five patients with ALS and 12 controls underwent 3.0-T MR scanning, which measured Glu, NAA, and GABA. Finally, receiver operating characteristic (ROC) curves were created and the area under curve (AUC) was calculated to assess the diagnostic power. Logistic regression analysis revealed the usefulness of both Glu and NAA for the differentiation of ALS from controls (Glu, P = 0.009; NAA, P = 0.033). The ratio of Glu to NAA or GABA was significantly increased in patients with ALS (Glu/NAA, P = 0.027; Glu/GABA, P = 0.003). Both the AUCs were more than 0.7, with high specificity but low sensitivity. The present findings might indicate that both the Glu/NAA and the Glu/GABA ratios in the SMA could be potential biomarkers for the diagnosis of ALS.
肌萎缩侧索硬化症（ALS）的诊断需要同时存在上运动神经元和下运动神经元体征。然而，相当一部分 ALS 患者在疾病过程中缺乏上运动神经元体征。本研究旨在探讨通过磁共振波谱（MRS）测量的补充运动区（SMA）中的代谢物，包括谷氨酸（Glu）、N-乙酰天门冬氨酸（NAA）和γ-氨基丁酸（GABA），是否可以作为 ALS 的替代生物标志物。25 名 ALS 患者和 12 名对照者接受了 3.0-T MR 扫描，测量了 Glu、NAA 和 GABA。最后，创建了受试者工作特征（ROC）曲线，并计算了曲线下面积（AUC），以评估诊断能力。逻辑回归分析显示，Glu 和 NAA 均有助于将 ALS 与对照组区分开（Glu，P = 0.009；NAA，P = 0.033）。ALS 患者的 Glu 与 NAA 或 GABA 的比值显著升高（Glu/NAA，P = 0.027；Glu/GABA，P = 0.003）。AUC 均大于 0.7，具有较高的特异性但较低的敏感性。这些发现可能表明，SMA 中的 Glu/NAA 和 Glu/GABA 比值均可能是 ALS 诊断的潜在生物标志物。
