基于扩散张量成像探究成人原发性甲状腺功能减退症患者胼胝体微观结构变化

Exploring Changes in the Microstructure of the Corpus Callosum in Adult Primary Hypothyroidism Based on Diffusion Tensor Imaging

目的 采用扩散张量成像研究成人原发性甲状腺功能减退患者胼胝体亚区微观结构变化及与认知、情绪改变的关系。资料与方法 前瞻性收集2019年10月—2021年9月在甘肃省人民医院就诊的32例甲状腺功能减退患者(甲状腺功能减退组)和33例健康志愿者(对照组)的临床信息、认知心理量表评分、扩散张量成像图像等,分析两组胼胝体亚区扩散指标的差异,并与甲状腺相关激素水平和神经心理量表评分进行相关分析,使用受试者工作特征曲线评价诊断效能。结果 与对照组相比,甲状腺功能减退组胼胝体膝部、体部各向异性分数减低,平均扩散率、径向扩散率和膝部轴向扩散率增高(P<0.01),上述扩散指标改变与认知和情绪存在相关性(r=-0.448~0.440,P=0.010~0.043),且膝部各向异性分数的曲线下面积最大(0.777)。结论 甲状腺功能减退患者存在胼胝体膝部和体部微观结构异常,两者分别与认知和情绪相关。本研究为进一步阐明甲状腺功能减退脑损害的神经病理生理机制提供了新的视角。

Purpose This study uses the diffusion tensor imaging to explore diffusion metrics changes of corpus callosum subregion,and to further analyze the relationship among these changes and the cognitive and emotional in adults with primary hypothyroidism.Materials and Methods From October 2019 to September 2021,32 hypothyroidism patients were recruited from Gansu Provincial Hospital,whereas 33 healthy controls were recruited through advertisements.The comprehensive thyroid-related hormone levels tests,as well as neurocognitive/neuropsychiatric assessment and diffusion tensor imaging data of all participants were carried out.The differences in corpus callosum subgroups of diffusion metrics between the two groups were recorded and compared,the partial relationships between these diffusion metrics and thyroid-related hormone levels and neurocognitive/neuropsychiatric function were analyzed and measured.Receiver operating characteristic curves were constructed to evaluate the diagnostic performance.Results Lower fraction anisotropy,higher mean diffusivity and radial diffusivity in genu and body of the corpus callosum and higher axial diffusivity in genu of the corpus callosum were found in hypothyroidism compared with healthy controls(P<0.01).These diffusion metrics were negatively correlated with cognition and emotion(r=-0.448-0.440,P=0.010-0.043),and the fraction anisotropy value in genu of the corpus callosum had the largest area under the curve(0.777).Conclusion Hypothyroidism patients show widespread microstructural changes within the genu and body of the corpus callosum,which,respectively,associated with cognition and emotion.This study provides a new perspective to further understanding the pathophysiology of the cerebral impairment in hypothyroidism.