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目的:采用运动皮质及相关脑区的质子磁共振波谱检查,分析上运动神经元明显受累的肌萎缩侧索硬化症患者嗅鞘细胞移植后质子谱变化。方法:于2004-12/2005-02在北京市石景山区西山神经再生和功能重建研究所治疗的7例肌萎缩侧索硬化症患者,均符合ElEscorial诊断标准。在嗅鞘细胞移植术前及术后2周检查其神经功能状态、肌萎缩侧索硬化症功能评分(分值越高神经功能越好)、肌电图和质子磁共振波谱。分别于大脑脚、内囊膝部、内囊后肢、放射冠和中央前回测量N-乙酰天冬氨酸/肌酐和胆碱复合物/肌酐比值。结果:7例肌萎缩侧索硬化症患者均进入结果分析。①嗅鞘细胞移植后2周2例患者功能评分较术前明显改善(术前29,30,术后34,30),肌电图波幅较术前明显升高。其余5例上述2项指标保持稳定。②7例患者N-乙酰天冬氨酸/肌酐和胆碱复合物/肌酐比值整体水平降低(波幅比值:1.624±0.347,1.531±0.193;1.030±0.269,0.919±0.115;曲线下面积:1.697±0.354,1.021±0.182;1.625±0.230,0.912±0.118),但2例改善的患者在其相应的解剖区域N-乙酰天冬氨酸/肌酐升高。结论:肌萎缩侧索硬化症患者N-乙酰天冬氨酸/肌酐和胆碱复合物/肌酐比值整体水平降低,可能是由于疾病的进展或穿刺操作的干扰有关。其中2例患者显示N-乙酰天冬氨酸/肌酐比值增高,而且与神经学检查发现相印证,并为肌电图检查所支持。
OBJECTIVE: To study the changes of proton spectra after the transplantation of olfactory ensheathing cells in amyotrophic lateral sclerosis patients with obvious involvement of motor neurons by proton magnetic resonance spectroscopy in motor cortex and related brain regions. Methods: Seven patients with Amyotrophic Lateral Sclerosis (ALS) treated at Xishan Nerve Regeneration and Functional Reconstruction Institute of Shijingshan District, Beijing from December 2004 to February 2005 all met ElEscorial diagnostic criteria. Neurological status, amyotrophic lateral sclerosis score (the higher the score was, the better neurological function), electromyography and proton magnetic resonance spectroscopy were examined before and 2 weeks after olfactory ensheathing cell transplantation. The ratios of N-acetyl-aspartate / creatinine to choline complex / creatinine were measured at the cerebral peduncle, knee of the internal capsule, hindlimb of the internal capsule, coronaviation, and central front. Results: All 7 patients with amyotrophic lateral sclerosis were involved in the result analysis. ① After 2 weeks of olfactory ensheathing cell transplantation, the functional scores of 2 patients were significantly improved compared with that before operation (29,30,30 and 34,30 after surgery), and the amplitude of EMG was significantly higher than that before the operation. The remaining 5 cases of the above two indicators remained stable. ② The overall level of N-acetyl-aspartate / creatinine and choline complex / creatinine ratio decreased in seven patients (amplitude ratio: 1.624 ± 0.347,1.531 ± 0.193; 1.030 ± 0.269,0.919 ± 0.115; area under the curve: 1.697 ± 0.354 , 1.021 ± 0.182; 1.625 ± 0.230, 0.912 ± 0.118), but two patients who improved improved N-acetyl-aspartate / creatinine in their respective anatomical regions. CONCLUSIONS: The overall N-acetyl-aspartate / creatinine and choline complex / creatinine ratio decreased in patients with amyotrophic lateral sclerosis and may be due to disease progression or interference with puncture procedures. Two of these patients showed an increased N-acetyl-aspartate / creatinine ratio, which was corroborated by neurological findings and supported by electromyography.