慢性失眠患者大脑灰质结构变化的磁共振影像学研究

Changes of gray matter structure of patients with chronic insomnia in magnetic resonance imaging

目的分析慢性失眠患者的全脑结构磁共振成像(MRI)特征,探讨慢性失眠患者大脑灰质结构的改变及其临床意义。方法收集2016年9月至2018年9月于内蒙古科技大学包头医学院第一附属医院神经内科门诊及病房就诊的慢性失眠患者35例,选择同期就诊于本院的睡眠正常者35名作为对照,于16:00时在安静、舒适的神经内科心理咨询室对其进行睡眠状况自评量表、匹兹堡睡眠质量指数量表、失眠严重指数、汉密尔顿抑郁量表、汉密尔顿焦虑量表及简易精神状态检查量表测评,之后对受试者进行结构MRI扫描,使用SPM8软件,通过基于体素的形态学分析方法分析横断面T1WI-选择性水激励快速梯度回波成像序列、T2WI-快速自旋回波序列、T2WI-液体衰减反转恢复序列等相关数据。结果与正常睡眠对照组相比,慢性失眠患者组的左背外侧额上回、眶额叶(左眶部额上回、右侧眶部额上中下回)、左楔前叶、左枕中回、双侧颞下回及左顶下缘角回的灰质体积减小,左枕中回、左楔前叶灰质体积与睡眠状况自评量表评分呈负相关(左枕中回:r=-0.482,P=0.003;左楔前叶:r=-0.358,P=0.035);左枕中回的灰质体积与汉密尔顿焦虑量表评分呈负相关(r=-0.348,P=0.040)。结论慢性失眠患者多个脑区的灰质体积发生变化,可能与慢性失眠患者的情绪、认知障碍有关。

Objective To explore the relationship between the structural changes of gray matter and the clinical characters of the patients with chronic insomnia.Methods Clinical data of 35 patients with chronic insomnia who attended the neurology clinic and ward of the First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology from September 2016 to September 2018 were collected.And 35 controls who had normal sleep during the same period were selected.The subjects were evaluated by the Self-Rating Scale of Sleep(SRSS),Pittsburgh Sleep Quality Index,Insomnia Severity Index,Hamilton Depression Scale,Hamilton Anxiety Scale(HAMA)and Mini-Mental State Examination scales in comfortable neurology counseling room,and then structural magnetic resonance imaging scans were performed,and the SPM8 software was used to analyze the cross-sectional T1-weighted turbo field echo of inversion pre-pulse excitation sequence,T2-weighted turbo spin-echo sequence,T2-weighted fluid attenuated inversion recovery sequence through voxel-based morphological analysis.Results Compared with the normal control group,the gray matter volumes of the left upper lateral frontal gyrus,orbitofrontal lobe(left orbital frontal gyrus,right orbital frontal and middle and lower gyrus),left wedge anterior lobe,left medial occipital gyrus,bilateral inferior temporal gyrus and left inferior parietal corner were reduced in the patients with chronic insomnia.The left medial occipital gyrus(r=-0.482,P=0.003)and left wedge anterior lobe gray matter volumes(r=-0.358,P=0.035)in the patients with chronic insomnia were negatively correlated with SRSS scores,and the left medial occipital gyrus gray matter volume(r=-0.348,P=0.040)in the patients with chronic insomnia was negatively correlated with HAMA scores.Conclusion The changes of gray matter volume in several brain regions may be related to emotional cognitive impairment in patients with chronic insomnia.