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目的利用 MRI 及 MR 波谱成像(MRS)研究肝硬化患者是否伴发帕金森综合征的基底节区信号与代谢特征。方法 27例肝硬化患者进行 MRI 与基底节区 MRS 扫描,其中14例肝硬化患者伴发帕金森综合征。采集 N-乙酰天冬氨酸(NAA)、肌醇(mI)、肌酸-磷酸肌酸(Cr)及胆碱复合物(Cho),分别计算 NAA/Cr、mI/Cr 及 Cho/Cr 的相对值。18名年龄匹配的健康志愿者作对比。结果27例肝硬化患者伴与未伴帕金森综合征组与正常对照组间的 NAA/Cr 的平均值分别为1.35±0.03、1.40±0.03、1.44±0.01差异无统计学意义(t 值分别为1.16与0.87,P 值均>0.05)。13例未伴帕金森综合征组与正常对照组间苍白球的高信号强度值的平均值分别为1.04±0.003,1.03±0.002,mI/Cr 平均值分别为0.63±0.01、0.61±0.02;Cho/Cr 的平均值分别为082±0.3、0.80±0.02,差异-无统计学意义(t 值分别为0.63、-0.52、0.54,P 值均>0.05)。14例伴有与13例不伴有帕金森综合征组间苍白球的高信号强度值平均值分别为1.18±0.001,1.04±0.003,mI/Cr 平均值分别为0.39±0.02、0.63±0.01;与 Cho/Cr 的平均值分别为0.68±0.01,0.82±0.03,差异有统计学意义(t 值分别为-5.16、7.61、4.12,P 值均<0.01)。肝硬化患者高信号强度值与 mI/Cr(r=-0.764,P<0.05)及 Cho/Cr(r=-0.553,P<0.05)间呈负相关。结论基底节区 MRI 与 MRS 对判断肝性脑病锥体外系受损有重要的临床意义。
Objective To study basal ganglia signal and metabolic characteristics of Parkinson’s disease in patients with cirrhosis by MRI and MR spectroscopy (MRS). Methods Twenty-seven patients with liver cirrhosis underwent MRI and basal ganglia MRS scans, of which 14 patients with cirrhosis were accompanied by Parkinson’s syndrome. NAA, mI, Cr and Cho were collected to calculate NAA / Cr, mI / Cr and Cho / Cr relative value. 18 age-matched healthy volunteers for comparison. Results The mean values of NAA / Cr in 27 cirrhotic patients with and without Parkinson’s syndrome were 1.35 ± 0.03, 1.40 ± 0.03 and 1.44 ± 0.01 respectively, with no significant difference (t = 1.16 and 0.87, P> 0.05). The average values of high signal intensity of globus pallidus in 13 cases without Parkinson’s syndrome group and normal control group were 1.04 ± 0.003 and 1.03 ± 0.002 respectively, and the average values of mI / Cr were 0.63 ± 0.01 and 0.61 ± 0.02 respectively. Cho / Cr were 082 ± 0.3,0.80 ± 0.02 respectively, the difference was not statistically significant (t = 0.63, -0.52, 0.54, P> 0.05). The mean values of high signal intensity of 14 cases with globus pallidus and 13 cases without Parkinson ’s syndrome were 1.18 ± 0.001 and 1.04 ± 0.003 respectively, and the average values of mI / Cr were 0.39 ± 0.02 and 0.63 ± 0.01 respectively. And Cho / Cr were 0.68 ± 0.01 and 0.82 ± 0.03, respectively (t = -5.16, 7.61, 4.12, P <0.01 respectively). High signal intensity of patients with cirrhosis was negatively correlated with mI / Cr (r = -0.764, P <0.05) and Cho / Cr (r = -0.553, P <0.05). Conclusion Basal ganglion MRI and MRS have important clinical significance in judging extrapyramidal damage of hepatic encephalopathy.