动脉自旋标记技术对系统性红斑狼疮患者脑血流量的初步研究

Arterial spin labeling analysis of the cerebral blood flow in systemic lupus erythematosus patients

目的神经精神性狼疮是系统性红斑狼疮(systemic lupus erythematosus,SLE)最常见的并发症,其发病机制尚不明确,目前"脑血管病学说"占据主导地位,因此早期评估SLE患者脑血流改变具有重要价值。文中采用动脉自旋标记(arterial spin labeling,ASL)技术研究无明显神经精神症状的SLE患者脑血流情况。方法纳入2014年6月至2015年9月于南京军区南京总医院就诊的28例无明显神经精神症状的SLE患者(SLE组)和30例性别和年龄匹配的健康志愿者(对照组)行常规MRI和ASL数据采集及精神心理学量表检查,包括数字连接试验-A(number connection test-A,NCT-A)、数字符号试验(digital symbol test,DST)、焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depression scale,SDS)对2组受试者脑灰质、白质及全脑平均脑血流量(cerebral blood flow,CBF)值进行比较;运用SPM8软件对受试者CBF图进行基于体素的统计学分析,观察SLE患者脑血流变化的主要脑区,将差异脑区的CBF值与患者的临床资料行相关分析。结果与对照组相比,SLE组的灰质(40.5±3.7 vs 37.3±6.5,P=0.028)、全脑(38.0±3.5 vs 35.1±6.1,P=0.032)平均CBF值降低,其中显著降低的区域主要位于辅助运动区及邻近的扣带回中部、前扣带回、左侧额内侧回、左侧额下回及左侧岛叶(P<0.05,FWE校正)。相关分析显示,患者组NCT-A值与左侧额内侧回CBF值(r=-0.402,P=0.032)及左侧额下回CBF值(r=-0.382,P=0.045)呈负相关。结论利用ASL-MR灌注成像技术显示无明显神经精神症状的SLE患者存在CBF降低,且与患者的认知功能改变有关。

Objective Neuropsychiatric systemic lupus erythematosus（ SLE） is a common complication of SLE,whose pathogenesis is not yet clear but associated with the alteration of cerebral blood flow（ CBF） in some studies. This study was to investigate the CBF alteration in SLE patients without overt neuropsychiatric symptoms by arterial spin labeling（ ASL） MRI. Methods Twentyeight SLE patients without overt neuropsychiatric symptoms and 30age- and sex- matched healthy controls underwent conventional MRI and ASL examinations,and all received such neuropsychologic tests as number connecting test-A（ NCT-A）,digit symbol test（ DST）,self-rating anxiety scale（ SAS）, and self-rating depression scale（ SDS）. Independent sample-t test was used to detect the mean CBF in the whole brain,gray matter,and white matter of the SLE patients and healthy controls. The voxel-wise CBF maps of the two groups of subjects were further analyzed with the SPM8 software to compare the regional CBF between the two groups,followed by evaluation of the correlation between the regional CBF values and clinical markers. Results In comparison with the healthy controls,the SLE patients showed significantly reduced CBF in the gray matter（ 40. 5 ± 3. 7 vs 37. 3 ± 6. 5,P = 0. 028） and the whole brain（ 38. 0 ± 3. 5 vs35. 1 ± 6. 1,P = 0. 032）,especially in the supplementary motor area and the adjacent middle cingulate,anterior cingulate,left medial frontal gyrus,left inferior frontal gyrus,and left insula（ P﹤0. 05,FWE corrected）. The NCT-A score was negatively correlated with the CBF values of the left medial frontal gyrus（ r =- 0. 402,P = 0. 032） and left inferior frontal gyrus（ r =- 0. 382,P = 0. 045） of the SLE patients. Conclusion ASL and MRI showed significantly reduced cerebral blood flow in the SLE patient without overt neuropsychiatric manifestations,which was correlated with the change of the patient＇s cognitive function.