脑外伤后综合征患者前额叶质子波谱与执行功能的研究

摘要

目的：探讨脑外伤后综合征患者前额叶质子波谱（1H-MRS ）的特点及其与执行功能的关系。方法：对40例脑外伤后综合征患者（研究组）和20例正常对照者（对照组）行1H-MRS 检查，检测前额叶代谢产物 N－乙酰天冬门氨酸（NAA）、胆碱复合物（Cho）和肌酸复合物（Cr），系统自动完成 NAA／Cr、Cho／Cr、NAA／（Cho＋Cr）值的计算。应用言语流畅性测验（动物）、威斯康星卡片分类测验（WSCT）、汉诺塔（TOH）对受试者进行执行功能评定。结果：研究组左侧前额叶NAA／Cr、NAA／（Cho＋Cr）显著低于对照组，差异有统计学意义（P＜0．05）。研究组言语流畅总数、WSCT分类数、WSCT总错误数、WSCT持续错误数、TOH平均执行时间、TOH总分显著差于对照组，差异有统计学意义（P＜0．05）。研究组左侧前额叶NAA／Cr值与言语流畅总数（r ＝0．66，P ＜0．05）、WSCT 分类数（r ＝0．54，P ＜0．05）、TOH 总分呈正相关（r ＝0．58，P ＜0．05），与WSCT总错误数（r＝－0．53，P＜0．05）、WSCT持续错误数（r＝－0．47，P＜0．05）、TOH 平均执行时间呈负相关（r＝－0．67，P＜0．05）。结论：脑外伤后综合征患者的左额叶NAA明显下降，NAA下降可能是导致患者执行功能下降的原因之一。%Objective To identify the metabolic levels in prefrontal lobe in patients with post-concussion syndrome by proton magnetic resonance spectroscopy (1H-MRS), and to explore the relationship between metabolic levels and executive function. Methods The study was conducted in 40 patients with post-concussion syndrome and 20 normal controls. 1H-MRS on prefrontal lobe was performed in patients and controls, the NAA, Cho and Cr were measured and the ratios of NAA/Cr, Cho/Cr and NAA/(Cho + Cr) were determined. They were also evaluated executive functions by verbal fluency test (animal), Wisconsin Card Sorting Test (WSCT) and Tower of Hanoi (TOH). Results Compared with normal controls, the patients with post-concussion syndrome were significantly lower NAA/Cr and NAA/(Cho+Cr) ratios in left prefrontal lobe (P < 0.05). The NAA/Cr ratio in left prefrontal was significantly positive correlated with total scores of verbal fluency (r = 0.66, P < 0.05), categories of WSCT (r = 0.54,P < 0.05) and total score of TOH(r = 0.58, P < 0.05). The NAA/Cr ratio was significantly negative correlated with total errors (r = -0.53, P < 0.05) and persistent errors (r = -0.47, P < 0.05) of WSCT and mean executive time of TOH(r = -0.67, P < 0.05). Conclusions The metabolic levels of NAA in left prefrontal lobe in patients with post-concussion syndrome is significantly decreased , it is one cause of impaired executive functions.