躯体化障碍患者脑白质磁共振扩散张量成像研究

The Exploration of MR Diffusion Tensor Imaging in Cerebral white Matter of Somatization Disorder

目的运用MR扩散张量成像(DTI)检测躯体化障碍(SD)患者脑白质纤维超微结构的改变,探讨SD的发病机制。方法采用3.0T MR对23例SD患者(病例组)及23名健康志愿者(对照组)进行DTI扫描,测量受试者左右侧额叶白质纤维、胼胝体、左右侧扣带束、左右上、下纵束等感兴趣区(ROI)内主要白质纤维束的表观扩散系数(ADC)和各向异性分数(FA)值,并进行两组间比较,评估其在病例组和对照组之间的差异,分析有统计学差异脑区的FA值与病程的相关性。结果病例组胼胝体膝部FA值(0.771±0.038)较对照组降低(0.798±0.045,P=0.038),左侧下纵束、左右侧扣带束前部、左扣带束后部的ADC值(8.024±0.445,7.893±0.375,7.914±0.356,7.503±0.649)较对照组明显升高(7.679±0.331,P=0.005;7.544±0.552,P=0.016;7.665±0.310,P=0.016;6.721±0.580,P=0.007),FA值(0.601±0.035;0.615±0.026;0.611±0.028;0.603±0.038)较对照组明显降低(0.621±0.031,P=0.048;0.655±0.039,P=0.000;0.642±0.036,P=0.003;0.651±0.070,P=0.000),有差异脑区的FA值与病程之间无统计学相关性(r值-0.170、-0.087、0.020、-0.167、-0.102;P值0.438、0.736、0.928、0.447、0.674)。结论 SD患者扣带束、优势半球下纵束神经纤维完整性降低、超微结构异常,可能是SD患者病理生理基础之一,但是病程与神经纤维损伤程度未发现明显相关性。

Objective To explore the white matter fiber integrity in patients with Somatization disorder （SD） by using MR diffusion tensor imaging （ DTI）, and study the relationship between FA value of patients and illness course. Methods 23 patients with Somatization disorder and 23 healthy volunteers were examined with DTI. Fractional anisotropy （ FA）, apparent diffusion coefficient （ADC） were measured in the bilateral fibers of frontal white matter （ FWM）, genu （ anterior）, body and splenium（posterior） of corpus callosum, anterior part and posterior part of the bilateral cingulate fibers, superior longitudinal fasciculus （SLF）, and inferior longitudinal fasciculus （ILF）. Student＇s t -tests were used to evaluate the difference in two parameter values between SD patients and the control group, and the confidence level was not less than 95%. Correlation analysis between ROIs＇ FA value and illness course were examined. Results The FA value of the genu of corpus callosum in SD patients [ 0. 771 ± 0. 038 ] were lower than in the control group [ （0. 798 ± 0. 045）, P = 0. 038], and the FA value of the left ILF, bilateral anterior？ cingulate fibers, the left posterior cingulate fibers were significant lower in SD patients [ 0. 601±0. 035 ; 0.615 ± 0. 026; 0.611±0. 028 ; 0. 603 ± 0. 038 ] than in normal control group [ 0. 621 ± 0. 031,P = 0. 048 ;0. 655 ± 0. 039, P = 0. 000 ;0. 642 ± 0. 036, P = 0. 003 ;0. 651 ± 0. 070, P = 0. 000 ] respectively. The ADC value of the left ILF, bilateral anterior？ cingnlate fibers , the left posterior cingulate fibers were significantly increased in SD patients[ 8. 024 ± 0. 445, 7. 893 ± 0. 375, 7. 914±0. 356, 7. 503 ± 0. 649 ] than in normal control group[7. 679 ±0.331 ,P =0. 005;7. 544 ±0. 552,P =0. 016;7. 665 ±0. 310,P =0. 016;6. 721 ±0. 580,P =0. 007] respectively. There were no statistically significant correlation between illness course and FA value of SD[ r values -0. 170, -0.087, 0.020, -0. 167, -0. 102 ;P values 0. 438 , 0.736, 0.928, 0.447, 0.674]. Conclusion The fiber bundles of the dominant hemisphere ILF, cingulum in patients with SD patients have microstructural abnormalities, and these abnormalities may be a principal base in the pathophysiology of SD.