迪谢内肌营养不良骨骼肌磁共振成像研究  

Muscle magnetic resonance imaging of Duchenne muscular dystrophy

作　　者：李文竹[1] 郑艺明[1] 杜婧[2] 张巍[1] 吕鹤[1] 王朝霞[1] 肖江喜[2] 袁云[1] 

机构地区：[1]北京大学第一医院神经内科,100034 [2]北京大学第一医院放射科,100034

出　　处：《中华神经科杂志》2014年第1期16-20,共5页Chinese Journal of Neurology

基　　金：科技部国际合作课题资助项目（2010DFA31070）;科技部“十二五”重大专项课题资助项目（2011ZX09307-001-07）

摘　　要：目的 分析迪谢内肌营养不良（DMD）患者的大腿肌肉在MRI上所见的骨骼肌脂肪化规律以及相关危险因素.方法 对48例DMD患者进行双侧大腿肌肉MRI检查,分析T1WI序列上所见的大腿肌肉脂肪化程度和短反转时间反转恢复序列水肿改变规律,对大腿每块肌肉的脂肪化及水肿程度进行6级分级,分析受累肌肉脂肪化严重程度与体质量指数、不同肌肉的作用以及年龄、病程、dystrophin丢失程度之间的关系.结果 47例患者存在肌肉不同程度脂肪化,30例患者肌肉出现轻度水肿.与站立有关的大收肌、臀大肌、股四头肌和股二头肌平均脂肪化评分大于1.5分,与屈膝有关的半膜肌和半腱肌评分1.0～1.5分,与大腿内收有关的缝匠肌、长收肌和股薄肌评分在1.0分以下.骨骼肌MRI脂肪化总评分与体质量指数（r=0.395,P=0.013）、年龄（r=0.693,P=0.000）、病程（r =0.517,P=0.000）呈正相关并有统计学意义,与肌肉水肿以及肌纤维dystrophin丢失程度无相关性.结论 大腿不同肌肉脂肪化程度的差异与儿童先站立后行走的运动发育过程可能有关;除年龄、病程外,肥胖可能是DMD骨骼肌脂肪化的重要危险因素.Objective To evaluate the magnetic resonance imaging （MRI） changes of fatty infiltration in the thigh muscles of Duchenne muscular dystrophy （DMD） and related risk factors.Methods MRI was performed in the thigh muscles in 48 patients with DMD.Analysis of T1 images enabled us to describe muscle fatty infiltration and short inversion time inversion recovery images to describe muscle edema.The relationships between muscle fatty infiltration and body mass index,age,disease course and severity of muscle dystrophin loss were investigated.Results Forty-seven cases presented with muscle fatty infiltration and 30 cases presented with muscle edema.The mean fatty infiltration scores were over 1.5 in the adductor magnus,gluteus maximus,quadriceps and biceps femoris,which were mainly related to standing.The scores were between 1.0-1.5 in the semimembranosus and semitendinosus,which were mainly related to flexing knees.The scores were below 1.0 in the sartorius,adductor longus and gracilis,which were related to adduction of hip joints.The severity of fatty infiltration in muscles was significantly correlated with body mass index （r =0.395,P =0.013）,age （r =0.693,P =0.000） and disease course （r =0.517,P =0.000）,but not with the degree of muscle edema and dystrophin loss in muscles.Conclusions The differences between fatty infiltration in the thigh muscles uight depend on the motor development process from stand-up to walking in the affected children.In addition to age and disease course,adiposity is a risk factor for muscle fatty infiltration in DMD.

关 键 词：肌营养不良 杜氏 肌 骨骼 磁共振成像 人体质量指数 

分 类 号：R746.2[医药卫生—神经病学与精神病学]