联合不同区域脑容积比降低与早期阿尔茨海默病的相关性

The reduction of brain volume ratio in different regions is associated with early Alzheimer’s disease

目的:基于3D磁共振成像(MRI)的脑容积自动分析软件AccuBrain■探讨早期阿尔茨海默病(AD)患者各脑区结构容积比的差异特征。方法:收集2018年1月至2020年12月温州医科大学附属第一医院神经内科收治的早期AD患者(早期AD组)29例,健康者(对照组)20例。采用简易精神状态检查(MMSE)、通过改良巴氏指数评定的日常生活能力量表(ADL-MBI)、临床痴呆量表(CDR)对受检者进行神经心理学评估。使用全新的自动分割软件AccuBrain■精确计算脑内各区域的容积比。将2组受检者的不同脑区容积比进行比较分析,选择差异性脑区及感兴趣脑区进行二元Logistic回归分析及ROC曲线联合诊断分析。结果:早期AD组与对照组比,双侧海马区、杏仁核、侧脑室下角等脑容积差异均有统计学意义(P<0.05)。通过调整混杂因素后发现右侧海马体、右侧枕叶萎缩、右侧扣带回、左侧侧脑室下角、左侧岛叶萎缩脑容积形成的诊断体系可以用于早期AD的诊断(AUC=0.919)。同时筛选出差异有统计学意义的感兴趣脑区进行ROC曲线联合诊断分析,选择感兴趣区1~5,经Logistic回归分析建立模型1~5,其AUC分别为0.867、0.860、0.843、0.876、0.893。结论:早期AD患者出现多脑区萎缩;认知功能下降与内侧颞叶的萎缩、前额叶、枕叶及岛叶、扣带回等部位的灰质容积相关,右侧海马在联合诊断中具有重要作用;通过AccuBrain®技术可辅助早期AD的临床诊断。

Objective:AccuBrain■,an automatic brain volume analysis software based on 3D magnetic resonance imaging(MRI),was used to explore the differences in the volume ratios of each brain region in patients with early Alzheimer’s disease(AD).Methods:Twenty-nine patients with early AD and 20 healthy controls from the First Affiliated Hospital of Wenzhou Medical University during January 2018 to December 2020 were enrolled.Mini-mental state examination(MMSE),activity of daily living scale(ADL-MBI)and clinical dementia rating(CDR)were used for neuropsychological assessment.The new automatic segmentation software AccuBrain■ was used to accurately calculate the volume ratio of each region in the brain.The volume ratios of different brain regions of the two groups were analyzed by t test,rank sum test and collinearity analysis.The different brain regions and regions of interest were selected for binary Logistic regression and receiver operating characteristic(ROC)curve joint diagnostic analysis.Results:Compared with the control group,the early AD patients had significant brain volume differences in bilateral hippocampus,amygdala,and inferior horn of lateral ventricle.After adjusting the confounding factors,it was found that the brain volume of right hippocampus,right occipital lobe atrophy,right cingulate gyrus,left inferior horn of lateral ventricle,and left insular lobe atrophy could be used for the diagnosis of early AD(AUC=0.919).Meamwhile,regions of interest(ROI)1-5 were selected,and Logistic regression was used to establish models 1-5 to obtain predictive values and draw ROC curves.The AUC was 0.867,0.860,0.843,0.876,0.893,respectively.Conclusion:Multiple brain regions atrophy occurs in early AD patients.Cognitive decline is associated with atrophy of the medial temporal lobe and gray matter volume in the prefrontal lobe,occipital lobe,insular lobe,and cingulate gyrus.The right hippocampus plays an important role in the combined diagnosis.AccuBrain®technology can assist in the early clinical diagnosis of AD.