Page 65 - 2022-24-中国全科医学

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Corresponding author：ZHANG Xulai，Chief physician，Master supervisor；E-mail：xulaizhang@ahmhcentre.com
【Abstract】 Background Alzheimer's disease（AD） prevalence is increasing as aging advances worldwide，but its
diagnosis is difficult due to atypical early clinical symptoms. Therefore，exploring new and reliable imaging techniques to improve
early diagnosis rate of AD has become an important challenge in medical research. Objective To assess the correlation of amide
proton content in brain with clinical symptoms of AD. Methods 41 AD patients over 55 years old in Affiliated Psychological
Hospital of Anhui Medical University were enrolled from November 2019 to August 2021，and 37 healthy volunteers were
recruited at the same time. The Mini-Mental State Examination（MMSE） and the Behavioral Pathology in Alzheimer's Disease
Rating Scale（BEHAVE-AD） were used to evaluate the cognitive function，and behavioral symptoms，respectively. APTw MRI
was used to take cephalograms. Spearman rank correlation analysis was used to explore the relationship between content of brain
amide protons and psychiatric symptom factors in AD patients. Results （1）The results showed that the MMSE and BEHAVE-
AD scores were significantly different between AD patients and healthy controls（P<0.05）. AD patients had significantly
increased contents of amide protons in the right，left，and total hippocampus under 2 ut，and in the right，left and total
hippocampus under 4 ut，than did healthy controls（P<0.05）. But the contents of amide protons in the left and total hippocampus
under 3 ut in AD patients were lower than those in healthy controls（P<0.05）. （2）Spearman rank correlation analysis showed
that the content of amide protons in the right hippocampus under 2 ut was positively correlated with the scores of delusional
ideation factor（r S =0.574，P=0.040） and hallucinations factor（r S =0.595，P=0.032） and diurnal rhythm disturbances factor
（r S =0.591，P=0.033）. Under 3 ut，the content of amide protons in the right hippocampus was positively correlated with the
scores of delusional ideation factor（r S =0.588，P=0.034） and hallucinations factor（r S =0.572，P=0.041）and diurnal rhythm
disturbances factor （r S =0.650，P=0.016），whereas content of amide protons in the left hippocampus was negatively correlated
with the score of spatial orientation（r S =-0.590，P=0.034）. The amide proton content in the total hippocampus under 3 ut was
positively correlated with scores of delusional ideation factor（r S =0.625，P=0.022） and hallucinations factor（r S =0.606，
P=0.028）and diurnal rhythm disturbances factor （r S =0.611，P=0.026）. Under 4 ut，the content of amide protons in the
right hippocampus was positively correlated with the score of emotion factor（r S =0.615，P=0.025），whereas content of amide
proton in the left hippocampus was negatively correlated with scores of temporal orientation （r S =-0.570，P=0.042），attention
（r S =-0.570，P=0.042），and remote memory（r S =-0.732，P=0.004）. The amide proton content in the total hippocampus
under 4 ut was positively correlated with score of emotion factor（r S =0.580，P=0.038）. Conclusion We found that there
were abnormal changes in the content of amide protons in the hippocampus of AD patients，which may be related to the patients'
cognitive fuction and psychotic symptoms. This study may provide a new idea for clinical diagnosis of AD.
【Key words】 Alzheimer disease；Magnetic resonance imaging；Nervous system diseases；Aged；Cognition；
Correlation of data

阿尔茨海默病（Alzheimer disease，AD）作为目前 着良好的应用效果 ［7］ 。
世界第一大常见的中枢神经系统退化性疾病，在全球范 CEST 是一种全新的核磁共振（MR）对比成像技
围内影响了超过约 3 000 万人 ［1］ ，其起病早期无明显 术，不同于使用传统的 MR 对比剂，其通过两种或多种
的临床症状，故患者的确诊非常困难。AD 的临床表现 处于不同化学环境下的质子之间的化学交换产生成像
包括认知功能的下降，如记忆力进行性下降、定向力逐 对比 ［8］ ，可以观察到常规 MR 图像上难以观察到的信
渐缺失等，同时随病程不断进展，部分患者会伴发行为 号。酰胺质子转移加权（Amide proton transfer-weighted
和精神异常，如性格的改变、妄想、幻觉、焦虑、抑郁、 imaging，APT w）MR 作为一种特殊类型的 CEST，能够
易激惹等 ［2］ 。目前 AD 的发病机制尚不明确，可能是 观察到细胞内源性移动肽和蛋白质 ［9］ 。酰胺质子是人
遗传及环境的共同影响所致。最新的研究发现，星形胶 体中广泛存在的一类含氮的羧酸衍生物，是蛋白质的一
质细胞反应在 AD 的发病中起着重要的作用 ［3］ 。海马 种特殊类型。既往研究结果显示，多数 AD 患者脑内淀
体作为与人类记忆功能最密切的器官 ［4］ ，内部包含大 粉样蛋白浓度发生特异性改变 ［10］ ，可以作为 AD 的预
量星形胶质细胞 ［5］ 。AD 患者中最常见的活化细胞就 测指标之一。星形胶质细胞瘤 ［11］ 最常见的发病部位就
是星形胶质细胞 ［6］ 。星形胶质细胞变性也可引起星形 是海马体，与 AD 的发病部位、发病原因均有较大的联
胶质瘤，该肿瘤的临床表现与 AD 相近。化学交换饱和 系。已有大量研究证明，运用 APT w 可以有效观察星形
转移成像技术（chemical exchange saturation transfer mri 胶质细胞瘤及 AD 动物模型中的脑内酰胺质子变化 ［12］ ，
contrast，CEST）最常应用于星形胶质瘤的诊断，且有 但是对于 AD 的诊断研究仍有待发展。