Amide Proton Transfer-weighted Imaging of Patients with Alzheimer's Disease

doi:10.12114/j.issn.1007-9572.2022.0093

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (24): 3005-3012.DOI: 10.12114/j.issn.1007-9572.2022.0093

Special Issue: 阿尔茨海默病最新文章合辑；脑健康最新研究合辑

• Article • Previous Articles Next Articles

Amide Proton Transfer-weighted Imaging of Patients with Alzheimer's Disease

¹Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, China
²Anhui Mental Health Center, Hefei 230022, China
³Department of Geriatrics, Hefei Fourth People's Hospital, Hefei 230022, China
⁴Imaging Department, Hefei Fourth People's Hospital, Hefei 230022, China
⁵Department of Psychiatry, Hefei Fourth People's Hospital, Hefei 230022, China
⁶Anhui Clinical Research Center for Mental Disorders, Hefei 230022, China

Received:2022-03-01 Revised:2022-04-18 Published:2022-08-20 Online:2022-05-26
Contact: Xulai ZHANG
About author:
LI J W, LI Q, YANG S, et al. Amide proton transfer-weighted imaging of patients with Alzheimer's disease[J]. Chinese General Practice, 2022, 25 (24) : 3005-3012.

阿尔茨海默病患者的酰胺质子转移加权磁共振成像研究

¹230022　安徽省合肥市，安徽医科大学附属心理医院
²230022　安徽省合肥市，安徽省精神卫生中心
³230022　安徽省合肥市第四人民医院老年科
⁴230022　安徽省合肥市第四人民医院影像科
⁵230022　安徽省合肥市第四人民医院精神科
⁶230022　安徽省合肥市，安徽省精神心理疾病临床医学研究中心

通讯作者: 张许来
作者简介:
李经纬，李群，杨硕，等.阿尔茨海默病患者的酰胺质子转移加权磁共振成像研究[J].中国全科医学，2022，25（24）：3005-3012.[www.chinagp.net] 作者贡献：李经纬进行统计学处理，结果的分析与解释，撰写论文，进行论文的修订；李经纬、张许来进行研究的实施与可行性分析，负责文章的质量控制及审校；李经纬、李群、杨硕、冉志蓉、郑明明、朱囡囡、程鹏、陈苑苑、石丽进行数据收集、整理；张许来进行文章的构思与设计，对文章整体负责，监督管理。
基金资助:
国家重点研发计划(2016YFC1305902); 安徽省中央引导地方科技发展专项资金(S2020b07030004)

Abstract

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

摘要：

背景

随着全球老龄化进程的加剧，阿尔茨海默病（AD）的发病率也在逐年递增，由于其早期症状不典型，导致临床诊断困难。寻找新的可靠的影像学技术、提高早期AD的临床诊断率已成为医学研究中的重要挑战。

目的

探讨AD患者脑内酰胺质子含量变化与临床症状之间的关系。

方法

选取2019年11月至2021年8月于安徽医科大学附属心理医院首次门诊就诊及住院治疗的55岁以上AD患者为研究对象，归为AD组（n=41例）。同期招募健康志愿者纳入健康对照组（n=37）。采用简易智力状态检查量表（MMSE）与阿尔茨海默病病理行为评分表（BEHAVE-AD）分别评定两组认知功能与精神行为情况，运用酰胺质子转移加权（APT w）磁共振成像对两组受试者行颅脑摄片成像，采用Spearman秩相关分析探究脑内酰胺质子含量与认知功能、精神症状因子的关系。

结果

（1）AD组与健康对照组的MMSE和BEHAVE-AD评分比较，差异有统计学意义（P<0.05）。AD组2 ut下右侧海马、2 ut下左侧海马、2 ut下海马（总）、4 ut下右侧海马、4 ut下左侧海马、4 ut下海马（总）酰胺质子含量高于健康对照组，3 ut下左侧海马、3 ut下海马（总）区酰胺质子含量低于健康对照组（P<0.05）。（2）Spearman秩相关分析结果显示：2 ut下右侧海马区酰胺质子含量与偏执和妄想因子（r_s=0.574，P=0.040）、幻觉因子（r_s=0.595，P=0.032）、日夜节律紊乱因子（r_s=0.591，P=0.033）呈正相关；3 ut下右侧海马区酰胺质子含量与偏执和妄想因子（r_s=0.588，P=0.034）、幻觉因子（r_s=0.572，P=0.041）、日夜节律紊乱因子（r_s=0.650，P=0.016）呈正相关；3 ut下左侧海马区酰胺质子含量与定向力呈负相关（r_s=-0.590，P=0.034）；3 ut下海马（总）酰胺质子含量与偏执和妄想因子（r_s=0.625，P=0.022）、幻觉因子（r_s=0.606，P=0.028）、日夜节律紊乱因子（r_s=0.611，P=0.026）呈正相关；4 ut下右侧海马区酰胺质子含量与情感障碍因子（r_s=0.615，P=0.025）呈正相关；4 ut下左侧海马区酰胺质子含量与视空间（r_s=-0.570，P=0.042）、注意集中（r_s=-0.570，P=0.042）、记忆力（r_s=-0.732，P=0.004）呈负相关；4 ut下海马（总）酰胺质子含量与情感障碍因子（r_s=0.580，P=0.038）呈正相关。

结论

AD患者脑内海马区酰胺质子含量发生变化且这种变化可能与患者的认知和精神症状有关。

关键词: 阿尔茨海默病, 磁共振成像, 神经系统疾病, 老年人, 认知, 数据相关性

Jingwei LI,Qun LI,Shuo YANG, et al. Amide Proton Transfer-weighted Imaging of Patients with Alzheimer's Disease[J]. Chinese General Practice, 2022, 25(24): 3005-3012. DOI: 10.12114/j.issn.1007-9572.2022.0093.
李经纬,李群,杨硕等. 阿尔茨海默病患者的酰胺质子转移加权磁共振成像研究[J]. 中国全科医学, 2022, 25(24): 3005-3012. DOI: 10.12114/j.issn.1007-9572.2022.0093.

Figures/Tables 4

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组别	例数	MMSE评分〔M（P₂₅，P₇₅），分）〕						BEHAVE-AD评分〔M（P₂₅，P₇₅），分）〕
组别	例数	记忆力	视空间	注意集中	语言能力	定向力	总分	偏执和妄想	幻觉	行为紊乱	攻击行为	日夜节律紊乱	情感障碍	焦虑和恐惧	总分
AD组	41	0（0，3.50）	0（0，0.50）	0（0，1.00）	2.00（0，4.00）	1.00（0，7.00）	3.00（0，18.00）	2.00（0，9.00）	2.00（0，5.00）	2.00（0，5.50）	0（0，2.50）	1.00（0，2.00）	3.00（0，5.50）	6.00（0，12.00）	21.00（1.0，32.50）
健康对照组	37	6.00（5.00，6.00）	0（0，1.00）	5.00（4.50，5.00）	8.00（8.00，8.00）	10.00（9.00，10.00）	28.00（26.50，30.00）	0	0	0	0	0	0	0	0
Z值		-6.311	-2.216	-7.314	-7.843	-6.670	-7.483	-5.286	-5.441	-5.742	-4.199	-5.605	-4.809	-5.487	-5.988
P值		<0.001	0.027	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
组别	脑内酰胺质子含量（±s）^a
组别	2 ut下右侧海马	2 ut下左侧海马	2 ut下海马（总）	2 ut下右侧颞叶	2 ut下左侧颞叶	2 ut下颞叶（总）	3 ut下右侧海马	3 ut下左侧海马	3 ut下海马（总）	3 ut下右侧颞叶	3 ut下左侧颞叶	3 ut下颞叶（总）	4 ut下右侧海马	4 ut下左侧海马	4 ut下海马（总）	4 ut下右侧颞叶	4 ut下左侧颞叶	4 ut下颞叶（总）
AD组	0.90±0.25	1.26±0.35	2.02±0.56	0.76±.022	0.79±0.23	1.21±0.35	1.12±0.31	0.84±0.23	1.40±0.39	0.60±0.17	0.84±0.24	1.06±0.30	0.75±0.21	1.00±0.28	1.46±0.41	0.68±0.20	0.89±0.26	1.14±0.33
健康对照组	0.64±0.18	0.80±0.22	1.30±0.36	0.84±0.23	1.11±0.31	1.60±0.44	0.76±0.21	0.93±0.26	1.58±0.44	0.71±0.20	1.46±0.40	1.90±0.53	0.53±0.15	0.50±0.15	0.53±0.15	0.65±0.18	0.76±0.21	1.13±0.31
t值	2.893	3.344	3.403	-0.421	1.092	0.507	1.549	3.249	2.923	0.472	1.145	1.086	2.559	3.785	3.778	-1.383	0.519	-0.431
P值	0.008	0.003	0.002	0.678	0.286	0.617	0.134	0.003	0.007	0.641	0.264	0.289	0.017	0.001	0.001	0.18	0.609	0.671

组别	例数	MMSE评分〔M（P₂₅，P₇₅），分）〕						BEHAVE-AD评分〔M（P₂₅，P₇₅），分）〕
组别	例数	记忆力	视空间	注意集中	语言能力	定向力	总分	偏执和妄想	幻觉	行为紊乱	攻击行为	日夜节律紊乱	情感障碍	焦虑和恐惧	总分
AD组	41	0（0，3.50）	0（0，0.50）	0（0，1.00）	2.00（0，4.00）	1.00（0，7.00）	3.00（0，18.00）	2.00（0，9.00）	2.00（0，5.00）	2.00（0，5.50）	0（0，2.50）	1.00（0，2.00）	3.00（0，5.50）	6.00（0，12.00）	21.00（1.0，32.50）
健康对照组	37	6.00（5.00，6.00）	0（0，1.00）	5.00（4.50，5.00）	8.00（8.00，8.00）	10.00（9.00，10.00）	28.00（26.50，30.00）	0	0	0	0	0	0	0	0
Z值		-6.311	-2.216	-7.314	-7.843	-6.670	-7.483	-5.286	-5.441	-5.742	-4.199	-5.605	-4.809	-5.487	-5.988
P值		<0.001	0.027	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
组别	脑内酰胺质子含量（±s）^a
组别	2 ut下右侧海马	2 ut下左侧海马	2 ut下海马（总）	2 ut下右侧颞叶	2 ut下左侧颞叶	2 ut下颞叶（总）	3 ut下右侧海马	3 ut下左侧海马	3 ut下海马（总）	3 ut下右侧颞叶	3 ut下左侧颞叶	3 ut下颞叶（总）	4 ut下右侧海马	4 ut下左侧海马	4 ut下海马（总）	4 ut下右侧颞叶	4 ut下左侧颞叶	4 ut下颞叶（总）
AD组	0.90±0.25	1.26±0.35	2.02±0.56	0.76±.022	0.79±0.23	1.21±0.35	1.12±0.31	0.84±0.23	1.40±0.39	0.60±0.17	0.84±0.24	1.06±0.30	0.75±0.21	1.00±0.28	1.46±0.41	0.68±0.20	0.89±0.26	1.14±0.33
健康对照组	0.64±0.18	0.80±0.22	1.30±0.36	0.84±0.23	1.11±0.31	1.60±0.44	0.76±0.21	0.93±0.26	1.58±0.44	0.71±0.20	1.46±0.40	1.90±0.53	0.53±0.15	0.50±0.15	0.53±0.15	0.65±0.18	0.76±0.21	1.13±0.31
t值	2.893	3.344	3.403	-0.421	1.092	0.507	1.549	3.249	2.923	0.472	1.145	1.086	2.559	3.785	3.778	-1.383	0.519	-0.431
P值	0.008	0.003	0.002	0.678	0.286	0.617	0.134	0.003	0.007	0.641	0.264	0.289	0.017	0.001	0.001	0.18	0.609	0.671

	MMSE评分						BEHAVE-AD评分
	记忆力	视空间	注意集中	语言能力	定向力	总分	偏执和妄想	幻觉	行为紊乱	攻击行为	日夜节律紊乱	情感障碍	焦虑和恐惧	总分
2 ut下右侧海马	-0.253	-0.513	-0.513	-0.385	-0.351	-0.396	0.574^a	0.595^a	-0.078	0.458	0.591^a	-0.103	0.015	0.367
2 ut下左侧海马	-0.033	-0.228	-0.228	-0.148	-0.160	-0.216	0.039	0.217	0.025	0.207	0.006	0.029	-0.039	0.099
2 ut下海马（总）	-0.275	-0.513	-0.513	-0.358	-0.364	-0.405	0.325	0.458	-0.050	0.396	0.335	-0.072	0.033	0.232
3 ut下右侧海马	0.011	-0.285	-0.285	-0.099	-0.028	-0.075	0.588^a	0.572^a	-0.170	0.440	0.650^a	-0.063	-0.015	0.295
3 ut下左侧海马	-0.490	-0.285	-0.285	-0.443	-0.590^a	-0.509	0.006	0.103	0.095	0.225	0.112	0.078	-0.006	0.061
3 ut下海马（总）	-0.301	-0.513	-0.513	-0.301	-0.323	-0.324	0.625^a	0.606^a	-0.097	0.548	0.611^a	-0.049	0.039	0.359
4 ut下右侧海马	-0.208	0.000	0.000	-0.105	-0.151	-0.048	0.048	0.023	0.456	0.027	-0.126	0.615^a	0.386	0.179
4 ut下左侧海马	-0.732^a	-0.570^a	-0.570^a	-0.292	-0.449	-0.312	0.171	0.092	0.287	0.324	-0.041	0.322	0.224	0.135
4 ut下海马（总）	-0.542	-0.342	-0.342	-0.196	-0.276	-0.165	0.056	0	0.387	0.144	-0.156	0.580^a	0.338	0.105

	MMSE评分						BEHAVE-AD评分
	记忆力	视空间	注意集中	语言能力	定向力	总分	偏执和妄想	幻觉	行为紊乱	攻击行为	日夜节律紊乱	情感障碍	焦虑和恐惧	总分
2 ut下右侧海马	-0.253	-0.513	-0.513	-0.385	-0.351	-0.396	0.574^a	0.595^a	-0.078	0.458	0.591^a	-0.103	0.015	0.367
2 ut下左侧海马	-0.033	-0.228	-0.228	-0.148	-0.160	-0.216	0.039	0.217	0.025	0.207	0.006	0.029	-0.039	0.099
2 ut下海马（总）	-0.275	-0.513	-0.513	-0.358	-0.364	-0.405	0.325	0.458	-0.050	0.396	0.335	-0.072	0.033	0.232
3 ut下右侧海马	0.011	-0.285	-0.285	-0.099	-0.028	-0.075	0.588^a	0.572^a	-0.170	0.440	0.650^a	-0.063	-0.015	0.295
3 ut下左侧海马	-0.490	-0.285	-0.285	-0.443	-0.590^a	-0.509	0.006	0.103	0.095	0.225	0.112	0.078	-0.006	0.061
3 ut下海马（总）	-0.301	-0.513	-0.513	-0.301	-0.323	-0.324	0.625^a	0.606^a	-0.097	0.548	0.611^a	-0.049	0.039	0.359
4 ut下右侧海马	-0.208	0.000	0.000	-0.105	-0.151	-0.048	0.048	0.023	0.456	0.027	-0.126	0.615^a	0.386	0.179
4 ut下左侧海马	-0.732^a	-0.570^a	-0.570^a	-0.292	-0.449	-0.312	0.171	0.092	0.287	0.324	-0.041	0.322	0.224	0.135
4 ut下海马（总）	-0.542	-0.342	-0.342	-0.196	-0.276	-0.165	0.056	0	0.387	0.144	-0.156	0.580^a	0.338	0.105

Amide Proton Transfer-weighted Imaging of Patients with Alzheimer's Disease

阿尔茨海默病患者的酰胺质子转移加权磁共振成像研究

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