慢性梗阻性肺部病变患者脑皮质MRI形态学初步研究

The morphological study of brain cortical in chronic obstructive pulmonary disease

目的研究应用基于体素的形态学分析(VBM)方法,观察慢性梗阻性肺部病变(COPD)患者的大脑皮质变化。材料与方法搜集在住院中的COPD患者(患者组)25例和年龄、性别、文化背景等相似的志愿者(对照组)25例进行肺功能、精神状态检查及血气分析。二组均行3D T1WI检查,采用VBM、FSL分析软件(簇体积减少>70体素)。应用一般线性模型进行统计学分析,计算两组的全脑灰质总体积,基于体素比较两组全脑灰质各个体素体积的差异。结果COPD患者日常生活活动性、简易精神状态测试、视觉重建及数字记忆测试预测值明显低于正常人。患者额叶的双侧眶回、双侧额下回三角区(Broca区),以及双额内側回、右侧前岛回及深部核团等局部灰质体积较正常对照组减少(P值均<0.01)。以统计学t值最大的体素在MNI中的坐标值分析,萎缩最明显的Brodmann脑区主要有47脑区(额上叶皮层)、双侧的13脑区(岛叶皮层)、22脑区(颞上回),及双侧的32脑区(前上扣带回皮层)、24脑区(前下扣带回皮质)。结论COPD患者的多个脑区可出现皮层体积的减少。损伤区域主要涉及前额叶皮质,以及双额内側回、右侧前岛回。与阻塞性睡眠呼吸暂停、先天性中枢呼气不足综合征以及高海拔居民的脑损伤部位相一致。

Objective：In order to observe gray matter variation in patients with chronic obstructive pulmonary disease （COPD） via morphological analysis method of voxel-based morphometry （VBM） and FSL software. Materials and Methods：Twenty-ifve patients of COPD （patient group） and twenty-ifve volunteers matched with age, gender, cultural background and no history of neurologic or psychopathic disorders （control group） were recruited. All subjects were examined, including pulmonary function, mental state examination and blood gas. 3D T1WI of brain were performed on Siemens Verio 3.0 T MRI scanning. All the imaging were drawn to PC workstation and computed with software of FSL （cluster size reduced＆gt;70 voxel）. Statistical analysis was performed using the general linear model to detect whole brain gray matter volume differences between the two groups. Results：Compared with the control group, the patients with COPD had markedly lower scores in the activities of daily life, the Mini-Mental State Examination, and Visual Reproduction, and Figure Memory tests. Statistical correlation between two groups showed signiifcant gray matter volume loss in the regions of frontal lobe （bilateral orbital gyros, bilateral inferior frontal gyrus triangle）, medial frontal gyrus, right anterior insular gyrus, and deep nuclei （P〈0.01）. According to the statistics of t value maximum voxels in coordinate of MNI, the Brodmann regions of the brain, which obviously atrophy, were mainly in 47 brain regions （superior frontal gyrus）, the bilateral 13 brain regions （insular cortex）, 22 brain regions （superior temporal gyrus）, bilateral 32 and 24 brain regions. Conclusions：In COPD patients, the cortex volume of multiple brain areas can reduce, the damage regions mainly relate to bilateral prefrontal cortex, medial frontal gyrus, and right anterior insular gyrus. The regions of brain cortex injury are consistent with other diseases, such as obstructive sleep apnea, congenital central expiratory deifciency syndrome, and the cerebral injury of people living in high altitude areas.