首诊重度阻塞性睡眠呼吸暂停男性脑白质结构与认知功能的关系  

Relationship Between White Matter Structure and Cognitive Function in Male Patients with First Diagnosis of Obstructive Sleep Apnea

作　　者：魏志鹏 李海军[1] 张娟 舒永强 刘翔[1] 彭德昌[1] WEI Zhipeng;LI Haijun;ZHANG Juan;SHU Yongqiang;LIU Xiang;PENG Dechang(Department of Radiology,the First Affiliated Hospital of Nanchang University,Jiangxi Province Medical Imaging Research Institute,Nanchang 330001,China)

机构地区：[1]南昌大学第一附属医院影像科,江西省医学影像研究所,江西南昌330001

出　　处：《中国医学影像学杂志》2021年第5期415-419,共5页Chinese Journal of Medical Imaging

基　　金：国家自然基金项目(81860307,81560285);江西省自然基金项目(20202BABL216036,20181ACB20023,20171BAB205070);江西省教育厅项目(700544006,GJJ190133);江西省卫生厅项目(20181039);南昌大学研究生创新课题项目(CX2019165)。

摘　　要：目的探讨中青年重度阻塞性睡眠呼吸暂停(OSA)男性患者大脑白质纤维结构的变化及其与认知功能的关系。资料与方法收集38例中青年男性重度OSA患者(OSA组)与38例健康对照(对照组)的扩散张量成像(DTI)指标和临床及认知功能量表评分。将两组DTI参数通过基于纤维素示踪的空间统计(TBSS)方法计算大脑白质差异区,并与其睡眠监测、蒙特利尔认知功能量表(MoCA)及腰围行偏相关性分析。结果与对照组相比,OSA组存在广泛的大脑白质纤维束异常;异常白质区的各向异性分数(FA)及轴向扩散系数(AD)值减低,径向扩散系数(RD)值增加,差异均有统计学意义(P<0.05)。偏相关分析发现,OSA患者FA降低与睡眠呼吸紊乱指数(AHI)呈负相关(0.3≤|r|<0.5,P<0.05),与血氧指标呈正相关(0.3≤|r|<0.5,P<0.05);AD降低与MoCA、AHI及腰围呈正相关(0.3≤|r|<0.5,P<0.05),与血氧指标呈负相关(0.3≤|r|<0.5,P<0.05);RD增高与血氧指标呈负相关(0.3≤|r|<0.5,P<0.05)。结论中青年男性OSA患者存在多个与认知相关的大脑白质区损伤,部分损伤白质脑区与认知及多导睡眠监测有关。Purpose To investigate the alterations of brain white matter fiber structure and its relationships with cognitive function in young and middle-aged men with severe obstructive sleep apnea(OSA).Materials and Methods Diffusion tensor imaging(DTI),clinical data and cognitive function evaluation scale were collected from 38 young and middle-aged male patients with severe OSA(OSA group)and 38 healthy controls(control group).The DTI parameters of these two groups were calculated via cellulose tract-based spatial statistics(TBSS)method,and the partial relationships between these DTI parameters and sleep monitoring,Montreal cognitive assessment(MoCA)and waist circumference were analyzed and measured.Results The OSA group had extensive abnormalities in the white matter fibrous tracts of the whole brain.Compared with the control group,fractional anisotropy(FA)and axial diffusion coefficient(AD)were significantly decreased in the anomalous white matter region,whereas radial diffusion coefficient(RD)was significantly increased in these regions between two groups(P<0.05).Partial correlation analyses showed that decreased FA was negatively correlated with apnea hyponea index(AHI)(0.3≤|r|<0.5,P<0.05),and positively correlated with blood oxygen index(0.3≤|r|<0.5,P<0.05).The decreased AD was positively correlated with MoCA,AHI and waist circumference(0.3≤|r|<0.5,P<0.05),and negatively correlated with blood oxygen index(0.3≤|r|<0.5,P<0.05).Increased RD was negatively correlated with blood oxygen index(0.3≤|r|<0.5,P<0.05).Conclusion There are multiple cognitive-related white matter lesions in the male patients with OSA,some of which are related to cognition and polysomnography monitoring.

关 键 词：阻塞性睡眠呼吸暂停 扩散张量成像 腰围 脑白质纤维 

分 类 号：R766[医药卫生—耳鼻咽喉科] R445.2[医药卫生—临床医学]