Brain metabolites in definite amyotrophic lateral sclerosis. A longitudinal proton magnetic resonance spectroscopy study.
Brain metabolites in definite amyotrophic lateral sclerosis. A longitudinal proton magnetic resonance spectroscopy study.
复制标题
明确肌萎缩侧索硬化症的脑代谢。
作者：
A. Unrath;A. Ludolph;J. Kassubek
肌萎缩性侧索硬化症（ALS）患者需要临床评估以外的生物标志物。本研究采用单体素质子磁共振波谱（hmrs）对包括锥体束在内的运动皮质灰质和白质进行纵向设计，研究明确ALS患者n -乙酰天冬氨酸（NAA）、肌酸（Cr）、胆碱（Cho）、肌醇、谷氨酸和谷氨酰胺的浓度（研究纳入时、3个月和6个月后进行了三次测量）。对感兴趣体积（VOI）内的灰质和白质分数进行体积校正分析，以确定绝对代谢物浓度。在第一次测量和第6个月之间，患者组在临床上受影响较重和较轻的半球的运动皮质区域，以及在第一次测量和第3个月之间，受影响较轻的一侧，随着时间的推移，复合NAA均显着下降。对于NAA/(Cr + Cho)比率，从第一次测量到第3个月和第6个月，以及从第3个月到第6个月，观察到受影响较小的半球显著下降。相比之下，脑白质区NAA和NAA/(Cr + Cho)比值均无明显变化。所有其他化合物都没有随时间发生显著变化。综上所述，在ALS过程中，皮质代谢物浓度的纵向变化可以通过优化的(1)H MRS技术在组水平上进行评估，因此(1)H MRS参数，特别是临床受影响较小的半球中NAA的体积校正值，似乎有可能作为监测ALS疾病进展的替代标志物。
Biomarkers beyond clinical assessment are needed in patients who suffer from amyotrophic lateral sclerosis (ALS). Here, single-voxel proton magnetic resonance spectroscopy ((1)H MRS) of the gray matter of the motor cortex and the white matter including the pyramidal tracts was used to investigate concentrations of N-acetylaspartate (NAA), creatine (Cr), choline (Cho), myoinositol, glutamate, and glutamine in patients with definite ALS in a longitudinal design (three measurements at study inclusion, after 3 and 6 months). A volume-corrected analysis of gray and white matter fractions within the volumes of interest (VOI) was performed for the identification of the absolute metabolite concentrations. The patient group showed a significant decline of the compound NAA over time in the motor cortex areas both of the clinically more and less affected hemisphere between first measurement and month 6 and for the less affected side additionally between first measurement and month 3. For the NAA/(Cr + Cho) ratio, significant decline in the less affected hemisphere was observed from the first measurement to month 3 and to month 6 as well as from month 3 to month 6. In contrast, neither NAA nor the NAA/(Cr + Cho) ratios in the white matter areas showed any significant alterations. All other compounds showed no significant changes over time. In summary, the longitudinal changes of cortical metabolite concentrations in the course of ALS could be assessed by optimized (1)H MRS techniques at group level, so that (1)H MRS parameters, in particular volume-corrected values of NAA in the clinically less affected hemisphere, seem to have the potential to serve as a surrogate marker for monitoring ALS disease progression.