Maeda H, Furune S, Nomura K, Kitou O, Ando Y, Negoro T, Watanabe K
Department of Radiological Technology, College of Medical Technology, Nagoya University.
Neuropediatrics. 1997 Oct;28(5):262-7. doi: 10.1055/s-2007-973711.
Apparent brain atrophy has been frequently observed at CT and MRI after ACTH therapy in patients with infantile spasms. There are several hypotheses to explain ACTH-induced brain shrinkage: 1) a catabolic effect of ACTH on brain tissue, 2) a mineralocorticoid effect resulting in a loss of water and 3) an increase in cerebrospinal fluid (CSF) pressure compressing the brain. An average of 0.21 +/- 0.03 mg/kg of ACTH was administered to nine patients over a period of 14 to 17 days. Water content and concentrations of N-acetylaspartate (NAA), creatine and phosphocreatine (Cr + PCr), and choline (Cho) were measured before, immediately after, and several months after the ACTH therapy by using in-vivo 1H magnetic resonance spectroscopy (MRS). Only NAA concentration exhibited a significant change during the study (6.6 +/- 1.5 mmol/kg, 5.4 +/- 1.1, and 7.0 +/- 1.5, p = 0.017). There was no significant change in Cr + PCr, in Cho, or in water content. These data suggest catabolic effects of ACTH on brain tissue, such as cell loss, decrease in NAA synthesis in mitochondria, and leakage of NAA from cell membrane.
在婴儿痉挛症患者接受促肾上腺皮质激素（ACTH）治疗后，CT和MRI检查常发现明显的脑萎缩。有几种假说来解释ACTH引起的脑萎缩：1）ACTH对脑组织的分解代谢作用；2）盐皮质激素效应导致水分流失；3）脑脊液（CSF）压力升高压迫大脑。9名患者在14至17天内平均接受了0.21±0.03mg/kg的ACTH治疗。在ACTH治疗前、治疗后即刻以及治疗后数月，使用体内1H磁共振波谱（MRS）测量了水含量以及N-乙酰天门冬氨酸（NAA）、肌酸和磷酸肌酸（Cr + PCr）以及胆碱（Cho）的浓度。在研究期间，只有NAA浓度出现了显著变化（分别为6.6±1.5mmol/kg、5.4±1.1和7.0±1.5，p = 0.017）。Cr + PCr、Cho或水含量没有显著变化。这些数据表明ACTH对脑组织有分解代谢作用，如细胞丢失、线粒体中NAA合成减少以及NAA从细胞膜泄漏。
