磁共振波谱技术在吸烟对大脑影响的研究进展
Progress of Magnetic Resonance Spectroscopy in the Study of the Effects of Smoking on the Brain
通讯作者: * Tel: +86-17717409269, E-mail:xiaoyong_zhang@fudan.edu.cn.
收稿日期: 2023-01-12
基金资助: |
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Corresponding authors: * Tel: +86-17717409269, E-mail:xiaoyong_zhang@fudan.edu.cn.
Received: 2023-01-12
吸烟是导致过早发病和死亡的主要风险因素之一.随着磁共振技术的不断进步,磁共振波谱已成为临床诊断的重要手段之一.与磁共振成像的其他模态一样,磁共振波谱具有无创性的优点,能够反映大脑的神经递质及代谢物的浓度变化情况.吸烟是一个全球性的健康问题,近些年已有一些研究利用磁共振波谱观察吸烟对大脑的影响.针对这一广泛关注的社会问题,本文对吸烟人群的磁共振波谱研究进展进行了综述,总结了烟草对大脑代谢的影响.本综述为深入研究烟草依赖的神经生物学机制提供了新的视角,从技术层面为早期诊断、治疗及预防吸烟对大脑的负面影响提供了支持.
关键词:
Smoking is one of the main risk factors for premature onset of illness and death. With the continuous advancement of magnetic resonance technology, magnetic resonance spectroscopy (MRS) has become a valuable diagnostic tool in clinical practice. Like other modalities of magnetic resonance imaging, MRS is non-invasive and can reflect changes in the concentration of neurotransmitters and metabolites in the brain. Smoking is a global health problem, and in recent years, some studies have applied MRS to observe the effects of smoking on the brain. This article reviews the progress in the use of MRS for studying the smoking population, summarizing the effects of tobacco on brain metabolism. This review provides a new perspective for in-depth research on the neurobiological mechanisms of tobacco dependence and technical support for the early diagnosis, treatment, and prevention of the negative effects of smoking on the brain.
Keywords:
本文引用格式
李任, 常晓, 张捷, 张孝勇.
LI Ren, CHANG Xiao, ZHANG Jie, ZHANG Xiaoyong.
引言
吸烟是一个全球性的健康问题[1],据世界卫生组织估计,目前全世界有大约11亿烟民,每年因吸烟而死亡的人数超过700万[2].我国是世界上最大的烟草生产和消费国,吸烟人数高达3.2亿,每年有100多万人死于烟草相关的疾病[3].研究表明,吸烟是诸多慢性疾病的危险因素,如肺癌等呼吸系统疾病以及中风等心脑血管系统疾病.对于试图戒烟的吸烟者来说,仅3%~5%的吸烟者能够凭借个人的毅力成功戒烟[4]. 近年来,不断发展的磁共振成像(Magnetic Resonance Imaging,MRI)技术为人们研究脑结构和脑功能提供了新的方法.磁共振波谱(Magnetic Resonance Spectroscopy,MRS)是一种能无创观察组织代谢变化并直接评估各种代谢产物浓度的磁共振技术.检测代谢物浓度和代谢物比率的变化可以提供有关神经损伤、膜代谢功能障碍和神经系统疾病中发生的传播缺陷的信息[5].MRS拓展了吸烟对大脑代谢功能影响的研究,本文将对MRS技术的基本原理、常用代谢物指标、成像序列、定量分析方法,以及MRS在吸烟对大脑代谢物影响研究中的进展进行综述(图1).
图1
图1
磁共振波谱技术在吸烟对大脑影响的研究进展
Fig. 1
Progress of MRS in the study of effects of smoking on the brain
1 MRS基本原理及常用代谢物指标
MRS是在均匀磁场中采集的,产生一个质子成分按频率分布的波谱图.对临床医生来说,MRI技术得到一个解剖图像,而MRS可以获得活体内生化参数定量信息和诊断信息.目前最常用的是31P-MRS和1H-MRS,31P-MRS能提供有关细胞能量状态、细胞内pH以及磷脂代谢的信息;1H-MRS即质子MRS,由于1H原子核自然丰度和相对灵敏性高,所以它是人体磁共振信号的主要来源.通过定量代谢物能够判断病变情况,再与MRI相结合,能够提高疾病的正确诊断率.表1总结了MRS检测的与吸烟对大脑影响相关的主要代谢物指标.
表1 MRS检测的与吸烟对大脑影响相关的主要代谢物指标
Table 1
代谢物名称 | 简写 | δH | 功能 |
---|---|---|---|
氮-乙酰天门冬氨酸 | NAA | 2.02 | 一种存在于神经元内的氨基酸,在抑制水MRS中最为突出,反映脑组织中神经元的数量和活化程度,NAA减少意味着神经元数量减少,说明神经元有可能坏死或被肿瘤组织替代[8]. |
胆碱 | Cho | 3.20 | 主要源自细胞膜裂解产物磷酸胆碱和磷酸甘油胆碱,与细胞膜代谢、细胞增殖或膜周转率相关 |
肌酸 | Cr | 3.03 | 肌酸存在于灰白质和各种神经细胞中,浓度的改变被认为反映线粒体功能障碍,以及脑能量代谢的变化[9].磷酸肌酸能提供细胞能量状态、细胞内pH以及磷脂代谢的信息.二者在正常大脑中的浓度含量较为稳定,常被看作内部参考值 |
磷酸肌酸 | PCr | 3.94 | |
谷氨酸谷氨酰胺复合物 | Glx | 2.40 | 由谷氨酸(Glutamate,Glu)和谷氨酰胺(Glutamine,Gln)组成,兴奋性神经递质,参与代谢产物和神经递质的合成,可反映谷氨酸能神经元的功能异常.Gln可水解生成Glu,二者在脑内突触连接正常发育和记忆中发挥着重要作用[10] |
γ-氨基丁酸 | GABA | 3.03 | 中枢神经系统中重要的抑制性神经递质,可抑制谷氨酸能神经元释放Glu,影响突触的形成及重塑 |
肌醇 | mI | 3.56 | 能够调节神经元渗透压,被认为是神经胶质细胞增殖的标志物. |
牛磺酸 | Tau | 3.47 | 一种含硫的非蛋白氨基酸,同时也是人体必需的营养素和条件性必需氨基酸之一[11] |
甘氨酸 | Gly | 3.56 | 内源性抗氧化剂还原型谷胱甘肽的组成氨基酸[12] |
谷胱甘肽 | GSH | 2.9/3.8 | 一种重要的抗氧化剂,能够清除掉人体内的自由基,清洁和净化人体内环境污染[13] |
2 MRS常用序列及定量分析工具
目前在磁共振波谱学中广泛采用的脉冲序列主要包括点分辨波谱(Point-resolved Spectroscopy,PRESS)和受激回波采集模式(Stimulated Echo Acquisition Mode,STEAM)两种.STEAM序列可以获得如肌醇、脂质等多种短T2代谢物的谱峰,对肿瘤的鉴别诊断很有意义,但存在对运动较敏感、且信噪比较低等缺点;PRESS序列所获得的谱峰虽较STEAM少,但具有扫描时间较短、信噪比较高等优点,它包含90°-180°-180°脉冲,每个射频脉冲都是层选脉冲,且梯度场作用在3个互相垂直的方向,可以得到定位区域内完整的信号[14].一些代谢物由于谱峰重叠难以准确地进行测量,如GABA.波谱编辑序列的发展为检测脑内代谢物提供了一些方法,如MEGA-PRESS(MEshcher-GArwood Point-resolved Spectroscopy)[15]、J-editing、2D-JPRESS等.MEGA-PRESS正迅速成为GABA波谱测量中的标准技术.它通过利用GABA分子内的已知耦合,将GABA信号与其他代谢产物的叠加信号分离.而J-editing使用基于同核J耦合的编辑脉冲序列来检测GABA等代谢物.2D-JPRESS则采用一种二维J分辨磁共振波谱提取方法,从Gln以及其他代谢产物中分辨Glu.
LCModel在UNIX环境中工作,用于1H-MRS数据分析.LCModel能自动计算代谢物浓度,将峰值位置、峰值强度和相位信息纳入分析.这些信息被纳入一个基础集,包括每个代谢物的单独波谱.将测得的MRS数据与来自该基础集合的波谱的线性组合进行比较,以获得与观察到的体内1H-MRS的最佳拟合.而jMRUI软件使用基于java的图形用户界面来分析时域MRS数据,运行平台有Windows、Linux和Unix等.与LCModel相比,jMRUI还可以处理31P-MRS数据.jMRUI软件提供了许多定量方法,广泛分类为黑盒方法和交互式方法.黑盒方法是基于线性预测原理或状态空间形式.在交互式定量方法中,线宽和浓度是非线性模型的一部分,并通过非线性最小二乘方法将体内信号与代谢产物信号的组合进行拟合来优化.
3 吸烟对大脑代谢物的影响
尼古丁是烟草中的主要有害物质,进入体内后与受体结合,促使体内中枢神经系统神经递质的释放,包括多巴胺、乙酰胆碱、GABA和Glu等[19].神经递质释放后会形成奖赏机制,带来吸烟后短暂的满足感,使人体验到愉快的感觉.短期吸烟可以使脑血流量增加,可改善情绪,减轻焦虑,提高食欲,同时对记忆力、解决问题的能力也有一定的增强.越来越多的证据表明,MRS可以通过无创地测量兴奋性神经递质Glu和抑制性神经递质GABA等代谢物来帮助揭示吸烟成瘾的病理机制,对研究吸烟人群具有独特的贡献,用MRS测量的Glu以及GABA的浓度可能有助于识别或作为易复发吸烟者的生物标志物,并可能为开发针对Glu和神经炎症系统的更有效治疗方案提供机会.
与不吸烟的健康人群相比,大多数研究表明吸烟对脑内代谢物影响比较复杂,其中NAA、Cr、mI和Glu的绝对浓度在统计学上显著降低,Cho的绝对浓度显著升高,吸烟者表现出较差的决策能力和更大的冲动.2007年,Gallinat等[20]应用1H-MRS将吸烟者与非吸烟者相比,发现左侧海马(Hippocampus,HC)的NAA的绝对浓度显著降低.该结果与先前观察到的尼古丁对啮齿类动物海马神经元的损伤以及吸烟者的工作记忆缺陷是一致的.2011年,Prescot等[21]使用1H-MRS测定青少年前扣带回皮层(Anterior Cingulate Cortex,ACC),发现吸烟者中Glu、NAA、Cr和mI的绝对浓度显著降低.除了ACC,2016年,Durazzo等[22]研究发现吸烟者右背外侧前额叶皮层(Dorsolateral Prefrontal Cortex,DLPFC)的NAA、Cr、mI和Glu的绝对浓度也有所降低;同时吸烟者DLPFC的NAA和Glu的绝对浓度表现出更强的年龄相关性下降.Schulte等[23]在2017年的研究发现吸烟者与健康对照组之间背前扣带回皮层(Dorsal ACC,dACC)的Glx绝对浓度存在差异,GABA的绝对浓度在组间则无显著差异.
总之,这些结果为尼古丁在脑中发挥神经毒性作用增加了越来越多的证据.其中,NAA的浓度是研究吸烟者神经元损伤的主要参数.较高的NAA浓度与较好的神经认知和较低的冲动性相关.吸烟者的NAA浓度显著降低可能反映了吸烟影响个体脑内神经元的完整性及吸烟者长期接触尼古丁后突触形成的紊乱.Glu的变化可能反映了这些个体谷氨酸能神经传递的改变,从而干预突触连接以及脑的正常发育和记忆.在这些受试者中观察到的Cr和mI水平的降低可能分别暗示是能量状态和神经胶质代谢的改变. Cho与烟草暴露之间的正相关关系表明,吸烟会增加皮质膜的更新或改变细胞密度,从而可能预示炎症的发生.
4 吸烟对大脑代谢物影响的性别差异
有研究发现,吸烟对某些代谢物水平的影响因性别而异.2005年,Epperson等[24]初步发现尼古丁对GABA/Cr水平的调节因性别而异,与男性吸烟者相比,女性吸烟者的皮质GABA/Cr水平降低,特别是在卵泡期,并且皮质GABA/Cr浓度的月经周期性完全丧失.这也是女性在戒烟期间更容易出现抑郁症状的原因.2013年,Nilsen等[25]使用1H-MRS在阿尔茨海默病的大鼠模型中发现,与雌性相比,雄性HC的早期代谢物mI和NAA的绝对浓度较低,暗示着该疾病的早期神经化学标志物对于雄性和雌性是不同的.2020年,Liachenko等[26]利用1H-MRS发现在大鼠急性尼古丁给药后神经代谢状况存在明显的性别差异.雄性大鼠HC中的GABA、Tau、NAA和Cr的绝对浓度较高,伏隔核(Nucleus Accumbens,NAC)中的Tau的绝对浓度较高.此外,在基线检查时,雌性的神经代谢物之间的相关性比雄性强.雌性服用尼古丁后,ACC中代谢物间相关性显著增加,NAC和HC中代谢物间相关性显著减少,而雄性没有变化.雌性体内尼古丁对代谢物间相关性的影响大于雄性,了解这种性别差异可能有助于个体化治疗.
有证据表明甲基苯丙胺(冰毒的有效成分)成瘾与女性抑郁和焦虑的风险增加有关.有趣的是,选择性的尼古丁类似物可以缓解抑郁,并提高动物和人类的认知能力.2015年,Sung等[27]研究发现吸烟对甲基苯丙胺依赖受试者前扣带回高能聚合酶链反应水平的增加具有性别特异性影响.用31P-MRS测定了30名女性和27名男性甲基苯丙胺依赖受试者ACC中与甲基苯丙胺神经毒性有关的PCr的绝对浓度.结果显示,女性和男性甲基苯丙胺依赖受试者之间PCr浓度存在显著性差异.并且在女性中,吸烟量与PCr的绝对浓度也显著相关,这表明吸烟可能对重度甲基苯丙胺依赖女性的大脑聚合酶链反应水平产生更显著的积极影响,甚至对神经代谢有潜在的保护作用.
5 戒断及复发期间的大脑代谢物变化
大多数试图戒烟的吸烟者往往会复发,这主要是由于尼古丁戒断综合症(Nicotine Withdrawal Syndrome,NWS)的存在[28].多数研究表明,dACC在认知和自我控制过程中起着重要作用,这在尼古丁依赖中至关重要.而且越来越多的证据表明,谷氨酸参与介导尼古丁依赖.2011年,Mashhoon等[29]用1H-MRS测量研究发现,与能够在尼古丁替代疗法(Nicotine Replacement Therapy,NRT)的帮助下坚持戒烟瘾的人群相比,不能戒烟瘾即易复发组dACC的Glu/Cr水平显著降低.2020年,Abulseoud等[28]的研究发现,与尼古丁饱和状态相比,尼古丁戒断期间,dACC的Glu/Cr浓度降低.2021年,Steinegger等[30]将吸烟者在基线、戒断和饱足期间进行测量.结果发现吸烟者中更严重的尼古丁依赖与较低的Glu水平相关.有趣的是,戒断期间mI+Gly的绝对浓度高于基线水平,与尼古丁依赖严重程度和吸烟年限呈负相关.mI+Gly绝对浓度的增加可能意味着尼古丁戒断期间发生了神经炎症.这些结果表明,用1H-MRS测量的Glu以及mI+Gly的水平可能有助于识别或作为易复发吸烟者的生物标志物,并可能为开发针对Glu和神经炎症的更有效治疗方案提供可能.但也有研究发现dACC的Glu在戒断期间没有明显改变.Mennecke等[31]在2014年对12名吸烟者和12名非吸烟者的HC以及dACC用1H-MRS进行了两次检查,第1次是在常规吸烟期间,第2次是在尼古丁戒断的第3天.结果显示,与非吸烟者相比,吸烟者左侧扣带皮层的Cho/Cr显著降低.但6名吸烟者在戒断期间表现出左背侧前扣带回皮层Glx/Cr正常化.对照组和吸烟组之间缺乏Glu浓度变化可能因为样本量较小,吸烟者的Glu水平没有明显改变,或者变化太小,无法通过1H-MRS检测到.
有研究表明,除了dACC,岛叶皮层(Insular cortex)在尼古丁依赖中也可能起着关键作用,由于其众多的功能,岛叶皮层似乎在成瘾的发展中起着特殊作用[32].2013年,Gutzeit等[33]通过3-Tesla扫描仪上的1H-MRS对14名男性吸烟者和10名男性非吸烟者岛叶皮层的神经代谢物进行测量,发现吸烟者在戒断期间,岛叶皮层Gln的绝对浓度显著增加,Glu的绝对浓度略有增加.并且这些值在口服尼古丁替代治疗后趋于正常.对照组在所有三个阶段均未显示任何代谢变化.吸烟者急性尼古丁戒断会产生一种神经代谢反应模式,口服尼古丁替代品可部分逆转这种反应模式.这一结果与大脑中成瘾特异性神经代谢改变的表达一致,并证实了岛叶皮层可能在尼古丁依赖中起关键作用.而且先前针对成瘾性疾病和酒精戒断等症状的研究表明[34],特异性代谢物水平在MRS上的变化相当.因此,神经代谢变化可能不仅在尼古丁戒断的情况下发生,也可能发生在其他类型的戒断症状中.
6 吸烟与其他疾病间的联系
研究资料表明,吸烟可以减轻饮酒后不良症状.吸烟可能会使酒精中毒中皮层系统GABA的研究复杂化,持续吸烟也可能会促进酒精清醒[35].2006年,Mason等[36]用1H-MRS测量12个酗酒的男性患者在大约1周和1个月的无药清醒状态下枕叶皮层(occipital cortex)的NAA、Glx和GABA的绝对浓度.在1周后,不吸烟患者GABA的绝对浓度高于吸烟患者,但到1个月时,不吸烟患者GABA的绝对浓度下降,而吸烟者GABA的绝对浓度没有变化.在患者和健康受试者中,吸烟与Glu和Gln的绝对浓度增加相关.不吸烟患者早期戒断时GABA缺乏可能反映了酒精对GABA代谢酶的慢性影响、戒断期间谷氨酸能神经元的激活以及受体功能的依赖性相关缺陷.需要进一步的研究,包括评估吸烟对酒精依赖和非依赖受试者非枕叶GABA的影响,以获取这些发现的预后和治疗意义.
2014年,Chitty等[37]发现饮酒和吸烟在双相情感障碍(Bipolar Disorder,BD)患者中非常普遍.对64例BD患者和49例对照组(18~30岁)进行了关于烟酒使用的自我报告问卷调查,并应用1H-MRS测定了HC和ACC中GSH的绝对浓度.独立样本t检验显示,BD吸烟者GSH的绝对浓度显著降低.在患者和对照组中,HC中GSH的减少与黑色素沉着的严重程度相关,而黑色素沉着与记忆损伤紧密相关,从而支持HC在酒精导致记忆损伤中的作用.该结果初步表明患有BD的年轻人容易受到饮酒和吸烟的神经毒性作用的影响.2015年,Chitty等[38]又发现GSH绝对浓度的增加与饮酒量的减少和吸烟频率的减少相关.结果表明在BD早期改变危险的饮酒和吸烟模式与抗氧化能力的提高有关,因此可能是BD早期预防和干预的潜在靶点.
7 MRS技术在吸烟研究中的文献总结和发展方向
我们首先对本文中提及的吸烟对大脑影响的研究中所采用的MRS技术及相关序列、软件,以及感兴趣的脑区和代谢物变化进行了总结(表2).然后对MRS技术在吸烟研究中的发展方向进行了展望.
表2 本文中提及的研究所采用的MRS技术、序列、软件以及感兴趣的脑区和代谢物变化文献综述
Table 2
文献序号 | 技术 | 磁场强度 | 序列 | 处理软件 | 脑区 | 代谢物变化 |
---|---|---|---|---|---|---|
[20] | 1H-MRS | 3.0 T | PRESS | Program package* | HC\ACC | 吸烟者NAA降低 |
[21] | 1H-MRS | 3.0 T | PRESS | LCModel | ACC | 吸烟者Glu、NAA、Cr、mI降低 |
[22] | 1H-MRS | 4.0 T\1.5 T | STEAM | Program package* | DLPFC\ACC | 吸烟者Glu、NAA、Cr、mI降低 |
[23] | 1H-MRS | 3.0 T | MEGA-PRESS | LCModel | dACC | 吸烟者Glu、Gln增加 |
[24] | 1H-MRS | 2.1 T | J-editing sequence | Program package* | Occipital cortex | 雌性GABA/Cr降低 |
[25] | 1H-MRS | 7.0 T | PRESS | LCModel | HC | 雄性NAA、mI降低 |
[26] | 1H-MRS | 7.0 T | PRESS | LCModel | HC\ACC\NAC | 雄性GABA、Tau、NAA、Cr增加 |
[27] | 31P-MRS | 3.0 T | Chemical shift imaging free induction decay pulse sequence | jMRUI | ACC | 雌性PCr增加 |
[28] | 1H-MRS | 3.0 T | PRESS | LCModel | dACC | 戒断期间Glu/Cr降低 |
[29] | 1H-MRS | 4.0 T | 2D-JPRESS | LCModel | dACC | 易复发组Glu/Cr降低 |
[30] | 1H-MRS | 3.0 T | J-editing sequence | LCModel | NAC | 戒断期间mI+Gly增加 |
[31] | 1H-MRS | 3.0 T | PRESS | LCModel | HC\dACC | 吸烟者Cho/Cr降低 |
[33] | 1H-MRS | 3.0 T | PRESS | LCModel | Insular cortex | 吸烟者Glu、Gln增加 |
[36] | 1H-MRS | 2.1 T | J-editing sequence | LCModel | Occipital cortex | 吸烟者Glu、Gln增加 |
[37] | 1H-MRS | 3.0 T | PRESS | LCModel | HC\ACC | BD吸烟者GSH降低 |
[38] | 1H-MRS | 3.0 T | PRESS | LCModel | ACC | 吸烟频率减少GSH增加 |
*采用内部软件工具拟合波谱
(1)磁共振波谱成像(Magnetic Resonance Spectroscopic Imaging,MRSI)的应用.目前,在吸烟对大脑影响的大多数研究中,基本采用单体素波谱(Single Voxel Spectroscopy,SVS)技术,即通过选层以及梯度来选择矩形体积元素(称为单体素).对于大脑的特定区域,单个体素的大小通常以体积表示(例如20 mm ×20 mm×20 mm).单体素波谱空间具有定位精确、匀场均匀性好、水抑制好、分辨率高、灵敏度高和采集时间短等优点.但SVS数据中只能获得一个谱,所选择的体素体积大且呈块状,在测量时必须准确放置在感兴趣的区域,而且没有关于病变损伤和“正常”大脑区域的空间异质性的信息.如果要测量多个脑区,则更加耗时.因此未来的波谱技术将更倾向于多体素波谱,即MRSI.MRSI覆盖了由单个实验中的多个体素组成的较大区域,以时效方式比较大脑各个区域.多体素波谱通过引入相位编码梯度从多个相邻体素收集波谱数据,相位编码梯度可测量一维、二维和三维数据中的波谱.在MRSI中,可以从多个位置检测到代谢物,获取组织异质性信息,可以更好地判断疾病的病理过程,从而可以回顾性选择检查体素内的感兴趣区域.当然,在MRSI中还有许多挑战:被研究组织中的磁场不均匀、实验时间较长以及数据拟合复杂等.未来波谱技术的研究方向将需要更严格的系统标准以解决这些问题,尽量减少由于脂质和水抑制不足造成的波谱信号损失,同时减少采集时长,与MRI其他模态兼容.
(2)深度学习与MRS相结合.目前,深度学习与MRI相结合已成为研究热点之一,其与MRS的结合也是未来重要的研究方向之一.例如Lee等[39]报道了一种基于贝叶斯的卷积神经网络,用于MRS测定的代谢物浓度的定量分析,取得了优于LCModel量化的结果.另外,Chen等[40]提出了一种新的深度学习模型(ReLSTM),纯粹使用真实数据的重复样本,可学习从低信噪比的时域数据到高信噪比时域数据的映射,可在快速采集下对MRS数据进行高保真降噪.Ahmed等[35]提出了一种端到端的深度学习网络,利用1H-MRS原始数据对早期老年痴呆患者和正常对照进行分类,展示出可检测早期痴呆的性能.总之,深度学习在MRS中应用将促进吸烟对大脑影响的研究进展.
(3)发展杂核MRS技术.质子在生物体中的含量高、信号强,因此它是磁共振成像的主要研究对象.但杂核(例如31P、19F或23Na)等谱也具有很高的临床研究和应用价值[42,43].磷是组成细胞核酸的重要元素之一,是生物体遗传代谢、生长发育、能量供应等方面不可或缺的元素.然而关于31P-MRS的研究报道依然较少[27],因为31P核与质子相比,天然丰度和磁共振灵敏度较低.随着磁场强度的提高,成像的灵敏度、分辨率都有很大程度的提升,31P-MRS研究得以逐步开展.Ma等[44]利用自行研发的一种9.4 T高场1H/31P双调谐射频线圈在较短时间内获得了较高信噪比小鼠脑的31P-MRS,证明了高场强下开展31P-MRS研究的可行性.19F-MRS较多应用于细胞移植、迁移的示踪[45].Helsper等[46]联合1H-MRS及23Na-MRS研究了干细胞治疗脑疾病的疗效,为今后多核技术联用提供了新的视角.然而,上述杂核MRS在脑内的信号强度均较低,对其成像仍存在巨大的技术挑战.
8 总结与展望
综上所述,MRS作为无创性的研究大脑神经递质及代谢物的重要技术,在一定程度上可以辅助某些疾病的临床诊断,为研究人员提供全新的角度.尽管吸烟乃至成瘾对大脑结构和功能影响与众多综合因素有关,但MRS所提供的神经递质及代谢物的信息,在尼古丁依赖的研究方面具有不可替代的优势.针对吸烟这一广泛关注的社会问题,MRS技术为系统了解烟草依赖的神经生物学机制提供了更多证据,为早期诊断、治疗及预防吸烟对大脑的负面影响在技术层面提供了支持,对阐述烟草对大脑代谢的多方面影响具有重要意义.
目前MRS在吸烟的研究这一领域还存在一些亟待解决的问题,主要包括以下几点:(1)这些代谢物的变化在不同研究中得到的结论不一致,可能是由于研究对象的选择标准、研究区域、数据分析方法或MRS测量方法不同等原因;(2)技术方面受限:MRS采集时间长,分辨率低等;(3)研究的样本量偏小,且所选择的病例的戒断时间不同等.以上这几点也是近些年来应用MRS技术在该方面的研究较少的原因.
该领域未来的研究方向概括起来主要包括:(1)临床上多中心、大样本数据的收集;(2)多体素波谱技术与深度学习、快速成像等技术相结合;(3)建立规范化采集方案,推进MRS临床队列研究;(4)发展杂核MRS技术;(5)将MRS与脑结构、功能MRI相结合,研究神经递质代谢改变与脑区结构或功能改变之间的相关性.
利益冲突
无
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INSPECTOR: free software for magnetic resonance spectroscopy data inspection, processing, simulation and analysis
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In vivo magnetic resonance spectroscopy (MRS) is a powerful tool for biomedical research and clinical diagnostics, allowing for non-invasive measurement and analysis of small molecules from living tissues. However, currently available MRS processing and analytical software tools are limited in their potential for in-depth quality management, access to details of the processing stream, and user friendliness. Moreover, available MRS software focuses on selected aspects of MRS such as simulation, signal processing or analysis, necessitating the use of multiple packages and interfacing among them for biomedical applications. The freeware INSPECTOR comprises enhanced MRS data processing, simulation and analytical capabilities in a one-stop-shop solution for a wide range of biomedical research and diagnostic applications. Extensive data handling, quality management and visualization options are built in, enabling the assessment of every step of the processing chain with maximum transparency. The parameters of the processing can be flexibly chosen and tailored for the specific research problem, and extended confidence information is provided with the analysis. The INSPECTOR software stands out in its user-friendly workflow and potential for automation. In addition to convenience, the functionalities of INSPECTOR ensure rigorous and consistent data processing throughout multi-experiment and multi-center studies.
Abnormal hippocampal neurochemistry in smokers: evidence from proton magnetic resonance spectroscopy at 3 T
[J]. ,In animals, nicotine, the primary psychoactive constituent of tobacco smoke, reduces neurogenesis and increases cell loss in both hippocampus and cortex. Accordingly, tobacco smoking has been linked to reduced performance on cognitive paradigms requiring attention and working memory in humans. However, few prior studies have tested for evidence of structural brain alterations in human tobacco smokers. In this study, proton magnetic resonance spectroscopy was used to assess the effects of chronic smoking on neuronal integrity of the hippocampus and anterior cingulate cortex (ACC).Absolute concentrations of N-acetylaspartate, total choline (tCho), and total creatine were measured in the left hippocampus and ACC in 13 chronic tobacco smokers and 13 nonsmokers matched for age, sex, and education.The N-acetylaspartate concentration was significantly reduced in smokers relative to nonsmokers in the left hippocampus but not in the ACC. There were no group differences in the tCho and total creatine concentrations in either voxel. However, ACC tCho concentration was positively correlated with magnitude of lifetime exposure to tobacco smoke (pack-years).The results are consistent with prior observations of hippocampal neuronal damage in rodents receiving nicotine and working memory deficits in human tobacco smokers. The positive relationship between tCho and lifetime tobacco exposure suggests that a component of tobacco smoke, presumably nicotine, may increase cortical membrane turnover or modify cell density. Together, these results add to growing evidence that nicotine exerts neurotoxic effects in human brain, although an a priori nature of the findings cannot be ruled out.
Neurochemical alterations in adolescent chronic marijuana smokers: a proton MRS study
[J]. ,DOI:S1053-8119(11)00200-X PMID:21349338 [本文引用: 2]
Converging evidence from neuroimaging and neuropsychological studies indicates that heavy marijuana use is associated with cingulate dysfunction. However, there has been limited human data documenting in vivo biochemical brain changes after chronic marijuana exposure. Previous proton magnetic resonance spectroscopy studies have demonstrated reduced basal ganglia glutamate and dorsolateral prefrontal cortex N-acetyl aspartate levels in adult chronic marijuana users. Similar studies have not been reported in adolescent populations. The present study used proton magnetic resonance spectroscopy to determine whether reductions in glutamate, N-acetyl aspartate and/or other proton metabolite concentrations would be found in the anterior cingulate cortex (ACC) of adolescent marijuana users compared with non-using controls. Adolescent marijuana users (N=17; average age 17.8 years) and similarly aged healthy control subjects (N=17; average age 16.2 years) were scanned using a Siemens 3T Trio MRI system. Proton magnetic resonance spectroscopy data were acquired from a 22.5 mL voxel positioned bilaterally within the ACC. Spectra were fitted using commercial software and all metabolite integrals were normalized to the scaled unsuppressed water integral. Analysis of variance and analysis of covariance were performed to compare between-group metabolite levels. The marijuana-using cohort showed statistically significant reductions in anterior cingulate glutamate (-15%, p<0.01), N-acetyl aspartate (-13%, p=0.02), total creatine (-10%, p<0.01) and myo-inositol (-10%, p=0.03). Within-voxel tissue-type segmentation did not reveal any significant differences in gray/white matter or cerebrospinal fluid content between the two groups. The reduced glutamate and N-acetyl aspartate levels in the adolescent marijuana-using cohort are consistent with precedent human (1)H MRS data, and likely reflect an alteration of anterior cingulate glutamatergic neurotransmission and neuronal integrity within these individuals. The reduced total creatine and myo-inositol levels observed in these subjects might infer altered ACC energetic status and glial metabolism, respectively. These results expand on previous functional MRI data reporting altered cingulate function in individuals with marijuana-abuse.Copyright © 2011 Elsevier Inc. All rights reserved.
Chronic cigarette smoking in healthy middle-aged individuals is associated with decreased regional brain n-acetylaspartate and glutamate levels
[J]. ,DOI:10.1016/j.biopsych.2015.03.029 URL [本文引用: 2]
Prefrontal Glx and GABA concentrations and impulsivity in cigarette smokers and smoking polysubstance users
[J]. ,DOI:S0376-8716(17)30359-9 PMID:28763779 [本文引用: 2]
Glutamate and GABA play an important role in substance dependence. However, it remains unclear whether this holds true for different substance use disorders and how this is related to risk-related traits such as impulsivity. We, therefore, compared Glx (as a proxy measure for glutamate) and GABA concentrations in the dorsal anterior cingulate cortex (dACC) of 48 male cigarette smokers, 61 male smoking polysubstance users, and 90 male healthy controls, and investigated the relationship with self-reported impulsivity and substance use. Glx and GABA concentrations were measured using proton Magnetic Resonance Spectroscopy. Impulsivity, smoking, alcohol and cocaine use severity and cannabis use were measured using self-report instruments. Results indicate a trend towards group differences in Glx. Post-hoc analyses showed a difference between smokers and healthy controls (p=0.04) and a trend towards higher concentrations in smoking polysubstance users and healthy controls (p=0.09), but no differences between smokers and smoking polysubstance users. dACC GABA concentrations were not significantly different between groups. Smoking polysubstance users were more impulsive than smokers, and both groups were more impulsive than controls. No significant associations were observed between dACC neurotransmitter concentrations and impulsivity and level and severity of smoking, alcohol or cocaine use or the presence of cannabis use. The results indicate that differences in dACC Glx are unrelated to type and level of substance use. No final conclusion can be drawn on the lack of GABA differences due to assessment difficulties. The relationship between dACC neurotransmitter concentrations and cognitive impairments other than self-reported impulsivity should be further investigated.Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.
Sex, GABA, and nicotine:the impact of smoking on cortical GABA levels across the menstrual cycle as measured with proton magnetic resonance spectroscopy
[J]. ,DOI:10.1016/j.biopsych.2004.09.021 URL [本文引用: 2]
Early differences in dorsal hippocampal metabolite levels in males but not females in a transgenic rat model of Alzheimer's disease
[J]. ,DOI:10.1007/s11064-013-1222-x PMID:24338370 [本文引用: 2]
McGill-R-Thy1-APP rats express the human amyloid precursor protein carrying the Swedish and Indiana mutations. We examined the neurochemical content of the dorsal hippocampus in three-months-old male and female transgenic rats and healthy age- and gender-matched controls using in vivo (1)H MRS in order to assess early metabolite alterations and whether these were similar for both genders. Whereas male and female controls had similar levels of all metabolites, differences were evident between male and female McGill-R-Thy1-APP rats. Compared with McGill-R-Thy1-APP females, McGill-R-Thy1-APP males had lower levels of myo-inositol and N-acetylaspartate (NAA). No differences in metabolite levels were evident when female control and McGill-R-Thy1-APP rats were compared, whereas McGill-R-Thy1-APP males had lower levels of glutamate, NAA and total choline compared with male controls. In addition to metabolite concentrations, metabolite ratios are reported as these are widely used. The results from this preliminary study demonstrate early metabolite alterations in the dorsal hippocampus of males in this rat model of Alzheimer's disease, and imply that very early possible neurochemical markers of the disease are different for males and females.
Sex differences in the effect of acute administration of nicotine on MRS-measured metabolic profile of the rat brain
[J]. ,DOI:S0168-0102(19)30173-7 PMID:31381938 [本文引用: 2]
Women are less able to stop smoking than men. Elucidation of sex differences in the tobacco addiction could facilitate personalized treatment. Specialized brain reward systems are controlling the behavior through reinforcement using specific neuromediators. Using non-invasive magnetic resonance spectroscopy (MRS) to ascertain addiction/harm biomarkers could lead to better management of public health through advancements in regulatory and translational research. Proton MRS was used to monitor changes of specific neurometabolites in hippocampus (HC), nucleus accumbens (NAC), and anterior cingulate cortex (ACC) of rats of both sexes after single intraperitoneal injection of nicotine. At the baseline, male rats showed higher level of GABA, taurine, N-acetyl aspartate, and creatine in HC, and taurine in NAC. Also, there were stronger correlations between neurometabolites in females than in males at the baseline. Nicotine administration changed taurine, GABA, myo-inositol, choline, and N-acetyl aspartate in HC, and taurine in NAC. Significant interactions between time, treatment, and sex were detected for taurine and choline in HC. The number of inter-metabolite correlations increased significantly in ACC and decreased in NAC and HC in females after nicotine administration, while in males it was unchanged. There are distinct sex differences in neurometabolic profiles at the baseline and after acute nicotine administration. Nicotine changes inter-metabolite correlations in females more than in males.Published by Elsevier B.V.
Gender differences in the effect of tobacco use on brain phosphocreatine levels in methamphetamine-dependent subjects
[J]. ,DOI:10.3109/00952990.2015.1019673 URL [本文引用: 3]
Short-term nicotine deprivation alters dorsal anterior cingulate glutamate concentration and concomitant cingulate-cortical functional connectivity
[J]. ,DOI:10.1038/s41386-020-0741-9 PMID:32559759 [本文引用: 3]
Most cigarette smokers who wish to quit too often relapse within the first few days of abstinence, primarily due to the aversive aspects of the nicotine withdrawal syndrome (NWS), which remains poorly understood. Considerable research has suggested that the dorsal anterior cingulate cortex (dACC) plays a key role in nicotine dependence, with its functional connections between other brain regions altered as a function of trait addiction and state withdrawal. The flow of information between dACC and fronto-striatal regions is secured through different pathways, the vast majority of which are glutamatergic. As such, we investigated dACC activity using resting state functional connectivity (rsFC) with functional magnetic resonance imaging (fMRI) and glutamate (Glu) concentration with magnetic resonance spectroscopy (MRS). We also investigated the changes in adenosine levels in plasma during withdrawal as a surrogate for brain adenosine, which plays a role in fine-tuning synaptic glutamate transmission. Using a double-blind, placebo-controlled, randomized crossover design, nontreatment seeking smoking participants (N = 30) completed two imaging sessions, one while nicotine sated and another after 36 h nicotine abstinence. We observed reduced dACC Glu (P = 0.029) along with a significant reduction in plasma adenosine (P = 0.03) and adenosine monophosphate (AMP; P < 0.0001) concentrations during nicotine withdrawal in comparison with nicotine sated state. This withdrawal state manipulation also led to an increase in rsFC strength (P < 0.05) between dACC and several frontal cortical regions, including left superior frontal gyrus (LSFG), and right middle frontal gyrus (RMFG). Moreover, the state-trait changes in dACC Glu and rsFC strength between the dACC and both SFG and MFG were positively correlated (P = 0.012, and P = 0.007, respectively). Finally, the change in circuit strength between dACC and LSFG was negatively correlated with the change in withdrawal symptom manifestations as measured by the Wisconsin Smoking Withdrawal Scale (P = 0.04) and Tobacco Craving Questionnaire (P = 0.014). These multimodal imaging-behavioral findings reveal the complex cascade of changes induced by acute nicotine deprivation and call for further investigation into the potential utility of adenosine- and glutamate-signaling as novel therapeutic targets to treat the NWS.
Anterior cingulate proton spectroscopy glutamate levels differ as a function of smoking cessation outcome
[J]. ,DOI:10.1016/j.pnpbp.2011.05.006 URL [本文引用: 2]
Neurometabolic alterations in the nucleus accumbens of smokers assessed with 1H magnetic resonance spectroscopy: the role of glutamate and neuroinflammation
[J]. ,DOI:10.1111/adb.v26.6 URL [本文引用: 2]
Physiological effects of cigarette smoking in the limbic system revealed by 3 tesla magnetic resonance spectroscopy
[J]. ,
Factors underlying prefrontal and insula structural alterations in smokers
[J]. ,DOI:10.1016/j.neuroimage.2010.08.008 PMID:20699124 [本文引用: 1]
Based upon previous reports of alterations in white matter integrity and gray matter density in smokers, we examined these markers in a large, well-matched sample of smokers and non-smokers. We further investigated the effect of heavy cigarette exposure by using pack-years and the effects of two relatively stable, highly heritable traits in smokers (Fagerström Test of Nicotine Dependence (FTND), a measure of severity of nicotine dependence and Toronto Alexithymia Scale (TAS-20), a stable personality trait related to smoking). Forty-eight nicotine-dependent subjects and 48 matched controls were included in the analyses, with smokers also subdivided into high/low dependence and high/low pack-years smokers. White matter integrity (fractional anisotropy (FA)) and gray matter density (voxel-based morphometry (VBM)) were measured and compared across groups. Gray matter density was lower in left prefrontal cortex (PFC) in high pack-years smokers and was inversely related to pack-years. In contrast, left insular cortex gray matter density was higher in smokers and associated with TAS-20 total score and with difficulty-identifying-feelings factor. Further, the most highly dependent smokers showed lower prefrontal FA, which was negatively correlated with FTND. There was no correlation between pack-years and FTND in our smoker population. These data suggest chronic tobacco use is correlated with prefrontal gray matter damage, while differences in insula gray matter and PFC white matter appear to reflect stable and heritable differences between smokers and non-smokers.Published by Elsevier Inc.
Insula-specific H magnetic resonance spectroscopy reactions in heavy smokers under acute nicotine withdrawal and after oral nicotine substitution
[J]. ,DOI:10.1159/000345915 PMID:23257512 [本文引用: 2]
The aim of this study was to clarify whether addiction-specific neurometabolic reaction patterns occur in the insular cortex during acute nicotine withdrawal in tobacco smokers in comparison to nonsmokers. Fourteen male smokers and 10 male nonsmokers were included. Neurometabolites of the right and the left insular cortices were quantified by magnetic resonance spectroscopy (MRS) on a 3-Tesla scanner. Three separate MRS measurements were performed in each subject: among the smokers, the first measurement was done during normal smoking behavior, the second measurement during acute withdrawal (after 24 h of smoking abstinence), and the third shortly after administration of an oral nicotine substitute. Simultaneously, craving, withdrawal symptoms, and CO levels in exhaled air were determined during the three phases. The participants in the control group underwent the same MR protocol. In the smokers, during withdrawal, the insular cortex showed a significant increase in glutamine (Gln; p = 0.023) as well as a slight increase not reaching significance for glutamine/glutamate (Glx; p = 0.085) and a nonsignificant drop in myoinositol (mI; p = 0.381). These values tended to normalize after oral nicotine substitution treatment, even though differences were not significant: Gln (p = 0.225), Glx (p = 0.107) and mI (p = 0.810). Overall, the nonsmokers (control group) did not show any metabolic changes over all three phases (p > 0.05). In smokers, acute nicotine withdrawal produces a neurometabolic reaction pattern that is partly reversed by the administration of an oral nicotine substitute. The results are consistent with the expression of an addiction-specific neurometabolic shift in the brain and confirm the fact that the insular cortex seems to play a possible role in nicotine dependence.Copyright © 2012 S. Karger AG, Basel.
Translational magnetic resonance spectroscopy reveals excessive central glutamate levels during alcohol withdrawal in humans and rats
[J]. ,DOI:10.1016/j.biopsych.2011.07.034 URL [本文引用: 1]
Smoking and drinking among alcoholics in treatment: cross-sectional and longitudinal relationships
[J]. ,DOI:10.15288/jsa.2000.61.157 URL [本文引用: 2]
Cortical gamma-aminobutyric acid levels and the recovery from ethanol dependence: preliminary evidence of modification by cigarette smoking
[J]. ,DOI:10.1016/j.biopsych.2005.06.009 URL [本文引用: 2]
The impact of alcohol and tobacco use on in vivo glutathione in youth with bipolar disorder: an exploratory study
[J]. ,DOI:10.1016/j.jpsychires.2014.03.024 URL [本文引用: 2]
A longitudinal proton magnetic resonance spectroscopy study investigating oxidative stress as a result of alcohol and tobacco use in youth with bipolar disorder
[J]. ,DOI:10.1016/j.jad.2015.01.021 URL [本文引用: 2]
Bayesian deep learning-based 1H-MRS of the brain: Metabolite quantification with uncertainty estimation using Monte Carlo dropout
[J]. ,DOI:10.1002/mrm.v88.1 URL [本文引用: 1]
DeepMRS: An end-to-end deep neural network for dementia disease detection using MRS data
[C]. ,
Design and evaluation of a 1H/31P double-resonant helmet coil for 3 T MRI of the brain
[J]. ,DOI:10.1088/1361-6560/aaf9e2 URL [本文引用: 1]
MRI and MRS of the human brain at magnetic fields of 14 T to 20 T: technical feasibility, safety, and neuroscience horizons
[J]. ,DOI:10.1016/j.neuroimage.2017.01.067 URL [本文引用: 1]
NMR-based analysis of age-related changes of phosphate metabolites in rat brain
[J]. ,
大鼠脑组织含磷代谢物随年龄变化的NMR研究
[J]. ,
19F magnetic resonance imaging and spectroscopy in neuroscience
[J]. ,DOI:10.1016/j.neuroscience.2021.03.016 PMID:33766776 [本文引用: 1]
H magnetic resonance imaging (MRI) has established itself as a key diagnostic technique, affording the visualization of brain anatomy, blood flow, activity and connectivity. The detection of other atoms (e.g. F, Na, P), so called hetero-nuclear MRI and spectroscopy (MRS), provides investigative avenues that complement and extend the richness of information that can be gained from H MRI. Especially F MRI is increasingly emerging as a multi-nuclear (H/F) technique that can be exploited to visualize cell migration and trafficking. The lack of a F background signal in the brain affords an unequivocal detection suitable for quantification. Fluorine-based contrast material can be engineered as nanoemulsions, nanocapsules, or nanoparticles to label cells in vitro or in vivo. Fluorinated blood substitutes, typically nanoemulsions, can also carry oxygen and serve as a theranostic in poorly perfused brain regions. Brain tissue concentrations of fluorinated pharmaceuticals, including inhalation anesthetics (e.g. isoflurane) and anti-depressants (e.g. fluoxetine), can also be measured using MRS. However, the low signal from these compounds provides a challenge for imaging. Further methodological advances that accelerate signal acquisition (e.g. compressed sensing, cryogenic coils) are required to expand the applications of F MR imaging to, for instance, determine the regional pharmacokinetics of novel fluorine-based drugs. Improvements in F signal detection and localization, combined with the development of novel sensitive probes, will increase the utility of these multi-nuclear studies. These advances will provide new insights into cellular and molecular processes involved in neurodegenerative disease, as well as the mode of action of pharmaceutical compounds.Copyright © 2021 IBRO. Published by Elsevier Ltd. All rights reserved.
Multinuclear MRI reveals early efficacy of stem cell therapy in stroke
[J]. ,DOI:10.1007/s12975-022-01057-w [本文引用: 1]
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