轻度阿尔茨海默病患者治疗前后海马亚区体积的磁共振成像研究

doi:10.3969/j.issn.1006-9771.2020.05.020

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (5): 592-596.doi: 10.3969/j.issn.1006-9771.2020.05.020

轻度阿尔茨海默病患者治疗前后海马亚区体积的磁共振成像研究

刘瑜¹,曹志宏^2a,罗一烽^2a(),单海荣^2a,谢文超^2a,张小洁^2b,王文云^2b

1.宜兴市第二人民医院放射科,江苏无锡市 214200
2.宜兴市人民医院,a.放射科;b.神经内科,江苏无锡市 214200

收稿日期:2019-07-21 修回日期:2019-10-17 出版日期:2020-05-25 发布日期:2020-05-29
通讯作者: 罗一烽 E-mail:luoyifeng1207@163.com
作者简介:刘瑜(1984-),女,汉族,江苏宜兴市人,硕士,主治医师,主要研究方向：神经影像学。
基金资助:
1.江苏省科教强卫工程项目(QNRC2016207);2.江苏省卫计委面上项目(H201656);3.无锡市卫计委科研项目(Z201610);无锡市卫计委科研项目(T201601);4.无锡市科技计划项目(CSZ0N1632)

Hippocampal Subfield Volumes before and after Treatment for Mild Alzheimer's Disease: Study with Magnetic Resonance Imaging

LIU Yu¹,CAO Zhi-hong^2a,LUO Yi-feng^2a(),SHAN Hai-rong^2a,XIE Wen-chao^2a,ZHANG Xiao-jie^2b,WANG Wen-yun^2b

1.Department of Radiology, Yixing Second People's Hospital, Wuxi, Jiangsu 214200, China
2.a. Department of Neurology; b. Department of Neurology, Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu 214200, China

Received:2019-07-21 Revised:2019-10-17 Published:2020-05-25 Online:2020-05-29
Contact: LUO Yi-feng E-mail:luoyifeng1207@163.com
Supported by:
Jiangsu Youth Medical Talents Project(QNRC2016207);Jiangsu Commission of Health and Family Planning Projects(H201656);Wuxi Commission of Health and Family Planning Projects(Z201610);Wuxi Commission of Health and Family Planning Projects(T201601);Wuxi Science and Technology Planning(CSZ0N1632)

摘要/Abstract

摘要：

目的观察轻度阿尔茨海默病(AD)患者盐酸多奈哌齐治疗前后海马MRI亚区体积变化,为轻度AD的临床早期诊疗提供影像学帮助。方法 2017年1月至2018年6月,轻度AD患者50例,随机分为治疗组(口服盐酸多奈哌齐)和安慰剂组,性别和年龄匹配的老年志愿者25例为对照组。治疗前和治疗6个月后,行MRI 3D快速场回波序列,采用FreeSurfer自动获取双侧海马各亚区体积进行组间比较,同时分析治疗前后简易精神状态检查(MMSE)评分变化。结果治疗前,与对照组比较,患者组左侧海马CA1、CA2-3和CA4-DG,右侧CA1和CA2-3体积缩小(t > 2.294, P< 0.05)。治疗后,治疗组左侧CA4-DG亚区体积较安慰剂组增大(t = 2.196, P< 0.05),而双侧CA1和CA2-3体积有增大趋势,但无显著性差异(t < 1.888, P> 0.065)。治疗后,治疗组MMSE评分较安慰剂组增加(t = 2.764, P< 0.05)。结论轻度AD患者药物治疗前后双侧海马不同亚区体积存在改变,左侧CA4-DG体积可能作为临床早期诊断和评价疗效的辅助指标。

关键词: 阿尔茨海默病, 海马, 磁共振成像, 诊断, 评定

Abstract:

Objective To investigate the hippocampal subfield volumes before and after taking hydrochloric donepezil in patients with mild Alzheimer's disease (AD).Methods From January, 2017 to June, 2018, 25 mild AD patients accepted hydrochloric donepezil (treatment group), 25 patients accepted placebo (placebo group) and 25 age- and gender-matched healthy old people (control group) were scanned with magnetic resonance imaging (MRI) under 3D-T₁ TFE sequence before and after a six-month treatment, and the automated segmentation of the hippocampus subfields was fulfilled with FreeSurfer and the hippocampus subfield volumes were compared, while the patients were assessed with Mini-Mental State Examination (MMSE).Results Compared with the control group, the volumes of left CA1, CA2-3 and CA4-DG, and right CA1 and CA2-3 were reduced in patients before treatment (t > 2.294, P< 0.05). The volume of left CA4-DG increased in the treatment group compared with that of the placebo group after treatment (t = 2.196, P< 0.05), and the volume of bilateral CA1 and CA2-3 tended to increase but not significantly (t < 1.888, P> 0.065). The MMSE score was more in the treatment group than in the placebo group after treatment (t = 2.764, P< 0.05).Conclusion The association with asymmetric atrophy in the hippocampal subfields has been found in mild AD patients, especially in left CA4-DG, which may be used as a valuable marker for diagnosis and evaluation for treatment at early stage.

Key words: Alzheimer's disease, hippocampus, magnetic resonance imaging, diagnosis, evaluation

中图分类号:

R749.1

刘瑜,曹志宏,罗一烽,单海荣,谢文超,张小洁,王文云. 轻度阿尔茨海默病患者治疗前后海马亚区体积的磁共振成像研究[J]. 《中国康复理论与实践》, 2020, 26(5): 592-596.

LIU Yu,CAO Zhi-hong,LUO Yi-feng,SHAN Hai-rong,XIE Wen-chao,ZHANG Xiao-jie,WANG Wen-yun. Hippocampal Subfield Volumes before and after Treatment for Mild Alzheimer's Disease: Study with Magnetic Resonance Imaging[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(5): 592-596.

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参考文献 20

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组别	n	性别 (男/女, n)	年龄(岁)	教育程度(年)
对照组	25	13/12	62.3±10.4	5.6±1.3
轻度AD组	25	14/11	63.8±10.6	6.3±2.0
χ²/t值		0.081	0.505	1.467
P值		0.777	0.616	0.149

组别	n	左CA1	左CA2-3	左CA4-DG	左下托	左旁下托	左海马伞
对照组	25	296.38±36.46	980.32±94.72	554.21±53.44	620.32±52.78	443.31±51.13	67.32±15.98
轻度AD组	25	269.36±35.88	915.45±93.18	517.37±55.03	612.75±50.22	429.17±53.08	61.62±15.90
t值		2.641	2.441	2.401	0.520	0.959	1.264
P值		0.011	0.018	0.020	0.606	0.342	0.212
组别	n	右CA1	右CA2-3	右CA4-DG	右下托	右旁下托	右海马伞
对照组	25	304.50±36.92	983.59±102.39	565.04±57.79	625.99±54.32	466.83±49.79	65.16±16.58
轻度AD组	25	280.16±38.11	916.21±99.82	550.32±56.90	630.21±55.12	455.76±47.10	63.77±15.68
t值		2.294	2.356	0.908	0.273	0.808	0.305
P值		0.026	0.023	0.369	0.786	0.423	0.762

组别	n	左CA1	左CA2-3	左CA4-DG	左下托	左旁下托	左海马伞
安慰剂组	25	271.14±34.97	916.32±94.21	516.42±55.12	616.45±51.06	427.19±55.12	61.45±16.07
治疗组	25	290.10±33.91	966.74±93.26	550.38±54.21	615.48±53.18	432.18±52.07	64.31±16.71
t值		1.946	1.902	2.196	0.066	0.329	0.617
P值		0.058	0.063	0.033	0.948	0.744	0.540
组别	n	右CA1	右CA2-3	右CA4-DG	右下托	右旁下托	右海马伞
安慰剂组	25	281.13±37.48	922.23±98.07	549.42±55.82	632.37± 55.33	457.88±48.90	63.99±16.34
治疗组	25	302.13±36.89	973.73±94.81	555.32±54.81	631.22±55.47	461.30±49.11	64.82±16.73
t值		1.997	1.888	0.377	0.073	0.247	0.178
P值		0.052	0.065	0.708	0.942	0.806	0.860

组别	n	治疗前	治疗后
安慰剂组	25	20.87±3.92	21.51±4.12
治疗组	25	21.38±4.03	24.83±4.37
t值		0.454	2.764
P值		0.652	0.008

轻度阿尔茨海默病患者治疗前后海马亚区体积的磁共振成像研究

Hippocampal Subfield Volumes before and after Treatment for Mild Alzheimer's Disease: Study with Magnetic Resonance Imaging

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