阻塞性睡眠呼吸暂停综合征脑白质损害磁共振弥散张量成像研究

White matter impairment in obstructive sleep apnea syndrome:a MR diffusion tensor imaging study

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者脑白质损害特点。方法对2008年3月至9月南方医科大学附属南方医院收治的10例男性OSAS患者和10名年龄及文化程度相当的男性健康志愿者行脑部T1WI、T2WI、FLAIR和磁共振弥散张量成像(DTI)扫描。分别测量部分各向异性分数值(FA)、平均扩散系数(ADC)并进行统计学分析。结果 OSAS组右侧额叶白质、胼胝体压部、左侧前部扣带回、右侧前部扣带回、左侧前部扣带、右侧前部扣带、左侧半卵圆中心、左侧前角周围白质、左侧后角周围白质、右侧后角周围白质、左侧海马旁回、右侧海马旁回、左侧外囊、右侧外囊的FA值分别为:0.444±0.025、0.776±0.028、0.154±0.021、0.152±0.017、0.372±0.022、0.351±0.029、0.501±0.029、0.242±0.031、0.338±0.029、0.360±0.022、0.167±0.027、0.177±0.023、0.441±0.034、0.449±0.036,与对照组相比显著下降(P<0.05),其他区域的FA值则无明显变化(P>0.05)。右侧额叶白质、胼胝体干、胼胝体压部、左侧前部扣带回、右侧前部扣带回、右侧前部扣带、左侧半卵圆中心、左侧前角周围白质的ADC值分别为:8.589±0.264、8.197±0.253、8.218±0.194、12.151±0.454、12.113±0.524、8.954±0.177、7.333±0.220、9.186±0.465,与对照组相比显著升高(P<0.05);而其他区域的ADC值则无明显变化((P>0.05)。结论 OSAS患者联络纤维、联合纤维和投射纤维等3种白质纤维同时受损;双侧前部扣带回、海马旁回等皮质也受累;DTI可作为早期发现OSAS白质损害、评估预后及治疗效果的一种重要工具。

Objective To investigate the characters of white matter impairment in patients with obstructive sleep apnea syndrome （OSAS）. Methods Cerebral T1WI, T2WI, FLAIR and DTI scans were performed in 20 male subjects （ l0 subjects with OSAS and 10 healthy controls） matched by age and educational level in Nanfang Hospital of Nanfang Medical University between March 2008 and September 2008. Fractional anisotropy （FA） and average diffusion coefficient （ADC） were measured and statistical analysis was performed in each section of ROI. Results The value of fractional anisotropy （FA） of white matter of right frontal lobe, splenium of corpus eallosum,left anterior cingulate gyrus, fight anterior cingulate gyrus,left anterior cingulum, fight anterior cingulum,left centrum semiovale, peripheral white matter of left anterior angle, peripheral white matter of left posterior angle, peripheral white matter of right posterior angle,left parahippocampal gyms, right parahippocampal gyrus, left external capsule and right external capsule was 0. 444 ± 0. 025,0. 776 ± 0. 028,0. 154 ± 0. 021,0. 152 ±0. 017,0. 372 ± 0. 022,0. 351 ± 0. 029,0. 501 ± 0. 029,0. 242 ± 0. 031,0. 338 ± 0. 029,0. 360 ± 0. 022, 0. 167 ± 0. 027,0. 177 ± 0. 023,0. 441 ± 0. 034 and 0. 449 ± 0. 036 in OSAS group, respectively. There was a significant decrease （ P 〈 0. 05 ） in FA compared with the control group. However, there was not a significant alteration （P 〉 0. 05 ） in the value of FA in other region of interests. The ADC value of white matter of right frontal lobe, trunk of corpus callosum, splenium of corpus callosum, left anterior cingulate gyms, right anterior cingulate gyms, fight anterior eingulum,left centrum semiovale and peripheral white matter of left anterior angle was 8. 589 ± 0. 264,8. 197 ± 0. 253, 8. 218 ± 0. 194,12. 151 ± 0. 454,12. 113 ± 0. 524,8. 954 ± 0. 177,7. 333 ±0. 220 and 9. 186 ± 0. 465 ,respectively,and there was a significant increase （P 〈 0. 05） compared with the control group. However, no significance （ P 〈 0. 05 ） was found in ADC value of other region of interests. Conehtsion Impairment could be found in the fiber of white matter, for instance, connective fiber, commissural fiber and projection fiber simultaneously. Involvement of the cortex, for example, bilateral anterior cingulate gyrus and parahippocampal gyrus could also be found in patients with OSAS. DTI could be an important tool for discovering early-stage lesion of white matter and assessing prognosis and therapeutic outcome in patients with OSAS.