0期无症状HIV相关性痴呆脑白质微细结构的DTI研究  

DTI Study on Microstructure of White Matter in Patients with Zero Stage Asymptomatic HIV-Associated Dementia Complex

作　　者：李瑞利[1] 李宏军[1] 米海峰[1] 赵晶[1] 员达[1] 柳娇娇[1] 齐石[1] 

机构地区：[1]首都医科大学附属北京佑安医院放射科,100069

出　　处：《临床放射学杂志》2014年第12期1813-1817,共5页Journal of Clinical Radiology

基　　金：北京市自然科学基金项目(编号:7132108);首都医学科技攻关发展项目(编号:2011-2018-01)

摘　　要：目的探讨0期无症状HIV相关性痴呆(HAD)常规MRI检查表现正常的脑白质磁共振扩散张量成像(DTI)的改变及其早期诊断价值。方法对32例0期无症状HAD患者和29名与之年龄、性别相匹配的健康志愿者为对照行MRI扫描,获取常规MRI(T1WI、T2WI、T2FLAIR)及DTI图像,测量其额叶、顶叶、颞叶、枕叶、胼胝体膝部、压部、内囊前、后肢白质区部分各向异性分数(FA)和表观扩散系数(ADC)。利用独立样本t检验比较HIV患者与对照组的FA值及ADC值。进一步根据CD4+计数将患者分为两组,即CD4+<200/mm3组、CD4+>200/mm3组,利用单因素方差分析比较CD4+<200/mm3组、CD4+>200/mm3组的HIV患者及对照组的FA值及ADC值。结果与正常对照组比较,0期无症状HAD患者的额叶、顶叶、颞叶、枕叶、胼胝体膝部、压部、内囊前、后肢白质的FA值均有所降低,但差异无统计学意义(P>0.05);对应ADC值呈不同幅度的增加:额叶、枕叶、内囊前肢白质显著增加(P<0.05),而顶叶、颞叶、胼胝体膝部、压部、内囊后肢白质区域的差异均无统计学意义(P>0.05)。另外,CD4+T细胞数<200/mm3的HIV患者额叶、枕叶白质的ADC值显著高于CD4+T细胞数>200/mm3的HIV患者及正常对照组(P<0.05),而对应FA值的差异均无统计学意义(P>0.05)。结论对无症状期HAD患者行定量DTI分析,有助于评价HAD患者在常规MRI检查表现正常的脑区的微结构改变,进而有助于HAD的早期诊治,阻止或逆转认知下降。定量ADC值的变化表明HAD疾病早期损害优先出现在额叶、枕叶,其结构特点(与高级皮层功能相关的脑区)可能是HAD早期易受损害的重要原因。此外,低CD4+T淋巴细胞计数可能是HIV患者进展为HAD的重要危险因素之一。Objective To investigate the quantitative diffusion tensor imaging （DTI） changes of normal-appearing white matter （NAWM） in patients with 0 stage asymptomatic HIV-associated dementia complex （HAD）. Methods A total of 32 patients with 0 stage asymptomatic HAD （study group） and 29 normal volunteers with matched age and sex （control group） were enrolled in this study. Conventional MRI and DTI were performed in all examinees, and T1WI, T2WI, T2FLAIR and DTI images were obtained. The fractional anisotropy （FA） and apparent diffusion coefficient （ADC） values of normal appearing white matter （NAWM） at frontal, parietal, temporal, occipital lobes, genu and splenium of the corpus callosum, and anterior and posterior limbs of the internal capsule were determined. Using independent sample t statistical test, the differences in the mean FA value and ADC value of each ROI of the chosen brain white matter regions between the two groups were analyzed. According to the CD4 ~ count the patients were divided into CD4^＋ count 〈 200 cell/ mm^3 group and CD4^＋ count 〉 200 cell/mm^3 group. By using single factor analysis variance, the differences in the mean FA value and ADC value were compared between each other among CD4^＋ count 〈 200 cell/mm^3 group, CD4^＋ count 〉 200 cell/ mm^3 group and the control group. Results Compared to the control group, in the study group the FA values of NAWM at frontal, parietal, temporal, occipital lobes, genu and splenium of the corpus callosum, and anterior and posterior limbs of the internal capsule were decreased, although the differences between the two groups were not statistically significant. Nevertheless, the corresponding ADC values at the frontal, occipital lobes and anterior limb of the internal capsule were significantly increased （P 〈0. 05）, while the differences in ADC values at the frontal, parietal lobes, genu and splenium of the corpus callosum and posterior limbs of the internal capsule were not significant between the two groups �

关 键 词：扩散张量成像 脑白质 HIV相关性痴呆 0期 无症状 

分 类 号：R512.91[医药卫生—内科学]