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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2004年12月~2005年2月,收治7例肌萎缩侧索硬化症(amy-otrophiclateralsclerosis,ALS)患者,男3例,女4例。年龄25~67岁。按ElEscorial诊断标准确诊。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、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例患者均进入结果分析。嗅鞘细胞移植后2周2例患者功能评分明显改善(ALS功能评分ALSFRS分别由30增至33分,29分增至34分),其余5例保持稳定。7例患者N-乙酰天冬氨酸/肌酐和胆碱复合物/肌酐整体水平降低(1.624降至1.531),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(NAA/Cr分别由1.236增至1.316,1.438增至1.560)。结论初步研究表明嗅鞘细胞移植术后2周内7例ALS患者中的2例明显改善。质子磁共振波谱是一项适用于肌萎缩侧索硬化评估的无创检查方法,但需更多病例数和长期随访进一步研究。
Objective To detect 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 From December 2004 to February 2005, 7 patients with amyotrophic lateral sclerosis (ALS) were treated, including 3 males and 4 females. Age 25 ~ 67 years old. Diagnosed by ElEscorial diagnostic criteria. Olfactory ensheathing cell transplantation before and 2 weeks after surgery to check their neurological status, amyotrophic lateral sclerosis function score, electromyography and proton magnetic resonance spectroscopy. 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 the 7 patients entered the result analysis. Two weeks after transplantation of OECs, functional scores of two patients were significantly improved (ALSFRS increased from 30 to 33, and 29 to 34), and the remaining 5 remained stable. The overall level of N-acetyl-aspartate / creatinine and choline complex / creatinine decreased (1.624 to 1.531) in seven patients, but two of the improved patients had N-acetyl-aspartate / creatinine in their respective anatomic regions (NAA / Cr increased from 1.236 to 1.316 and 1.438 to 1.560 respectively). Conclusions Preliminary studies have shown that 2 of 7 patients with ALS within 2 weeks after olfactory ensheathing cell transplantation have significantly improved. Proton magnetic resonance spectroscopy is a noninvasive method suitable for the assessment of amyotrophic lateral sclerosis but requires further study and long-term follow-up.