原发性开角型青光眼患者大脑相关皮层的形态学变化

Morphological changes of cerebral cortex in primary open-angle glaucoma patients under magnetic resonance imaging

目的 探讨原发性开角型青光眼（POAG）患者大脑相关皮层的形态学变化,为深入研究POAG的中枢损害机制提供依据.方法 2011年2月至2012年12月复旦大学附属华山医院眼科门诊就诊并确诊为POAG的患者30例,年龄26 ～ 82岁,男19例,女11例,选取与POAG患者年龄、性别相匹配的健康志愿者30名作为对照组.所有受试者都进行常规眼科检查.磁共振成像（MRI）检查使用Siemens Magneton Verio 3T MRI,采用12通道头部线圈,常规T1WI、T2WI及液体衰减反转恢复（FLAIR）扫描检查,确认受试者头颅无占位性及血管性等病变后纳入研究.全脑三维容积数据采用三维磁化强度预备梯度回波序列（3D-MPRAGE）.影像数据处理与统计分析使用SPM8及VBM8软件在Matlab 2012a平台上进行,处理过程包括脑的空间标准化、灰白质分割及空间平滑.POAG组和对照组的全脑灰质图像采用基于体素的形态学分析方法（VBM）进行统计学分析.本研究通过复旦大学附属华山医院伦理委员会批准.结果 与对照组相比,POAG组患者存在多个脑区的灰质体积减小,主要表现在枕叶（左舌回,t=3.207,P=0.002）、额叶（左额内侧回,t=2.912,P=0.004;右额上回,t=2.745,P=0.005）、颞叶（左颞中回,t=2.958,P=0.003）、顶叶（右楔前叶,t=3.291,P=0.001;右中央后回,t=3.306,P=0.001;左顶下小叶,t=2.716,P=0.006）、边缘叶（左海马回,t=2.815,P=0.005）等脑区.结果采用配对t检验,当t＞2.479时,P＜0.01,POAG组与对照组比较差异有统计学意义.结论 POAG患者的大脑皮层存在多区域的灰质体积的减少,印证了POAG是在大脑多方面、多层次造成损伤的综合征,除视觉通路损伤外,其他脑区也存在形态及功能的改变。

Objective To observe the morphology changes of cerebral cortex in primary open-angle glaucoma （POAG） patients,and to explore the damage mechanism in the central nerve system.Methods 30 patients,19 males and 11 females （age ranged from 26 to 82 years old）,who were diagnosed with POAG in the department of ophthalmology at Huashan Hospital of Fudan University from February 2011 to December 2012 were enrolled.Meanwhile,additional 30 age-and sex-matched patients were collected as controls.All subjects underwent a complete ophthalmic evaluation.As for magnetic resonance imaging （MRI）,we adopted the scans of T1WI,T2WI and fluid attenuated inversion recovery （FLAIR） on a Siemens Magneton Verio 3T MRI machine with a 12-channel head coil.Subjects with space occupying or vascular lesion in brain imaging were excluded from the study.The three-dimensional magnetization prepared rapid acquisition gradient echo sequence （3D-MPRAGE） was used to acquire the volume data of whole brain of all subjects.SPM8 and VBM8 toolbox were used to analyze the image data.Voxel-based analysis was done for whole brain grey matter images.Results Compared with the control group,the volume of grey matter from several brain regions of the POAG patients decreased.These structures included left lingual gyrus （t =3.207,P =0.002）,left medial frontal gyrus （t =2.912,P =0.004）,right superior frontal gyrus （t =2.745,P =0.005）,left middle temporal gyrus （t =2.958,P =0.003）,right precuneus （t =3.291,P =0.001）,right postcentral gyrus （t =3.306,P =0.001）,left inferior parietal lobule （t =2.716,P =0.006）,left parahippocampa gyrus （t =2.815,P =0.005）.The results were assessed with comparative t-test to perform statistical analysis.When t 〉 2.479,P 〈 0.01,the difference between the two groups was considered statistically significant.Conclusion The volume of grey matter in POAG patients＇ brain decreased in several regions.It is illustrated that POAG is a syndrome,which causes damages in the brain of POAG patients at multi-aspects and multi-levels.The damages contained not only injuries in the visual pathway,but also morphological and functional changes in many other brain regions.