弥散张量成像技术对系统性红斑狼疮合并认知功能障碍患者的诊断价值及发生认知功能障碍的危险因素分析  

Diagnostic Value of Diffusion Tensor Imaging in Patients with Systemic Lupus Erythematosus Complicated with Cognitive Impairment and Analysis of Risk Factors for Cognitive Impairment

作　　者：王磊[1] 郑桂敏[2] 张雪梅[2] 贾秀川[1] 张风肖[2] WANG Lei;ZHENG Gui-min;ZHANG Xue-mei;JIA Xiu-chuan;ZHANG Feng-xiao(Department of Medical Imaging,Hebei Provincial People's Hospital,Shijiazhuang,Hebei,050051,China;Department of Rheumatology and Immunology,Hebei Provincial People's Hospital,Shijiazhuang,Hebei,050051,China)

机构地区：[1]河北省人民医院医学影像科,河北石家庄050051 [2]河北省人民医院风湿免疫科,河北石家庄050051

出　　处：《现代生物医学进展》2022年第19期3729-3734,3649,共7页Progress in Modern Biomedicine

基　　金：河北省医学科学研究重点课题计划项目(20180185)。

摘　　要：目的:探讨弥散张量成像技术(DTI)对系统性红斑狼疮(SLE)合并认知功能障碍患者的诊断价值,并分析SLE发生认知功能障碍的危险因素。方法:选择2012年1月~2022年3月河北省人民医院收治的SLE患者92例,根据蒙特利尔认知功能评估量表(MoCA)评估结果分为合并认知功能障碍组(MoCA评分<26分,35例)和未合并认知功能障碍组(MoCA评分≥26分,57例)。比较两组常规磁共振结果和DTI检查结果,分析向异性分数(FA)、表观扩散系数(ADC)与MoCA评分结果的相关性。应用多因素Logistic回归分析SLE发生认知功能障碍的危险因素。结果:常规磁共振检查显示合并认知功能障碍组中14例患者出现异常信号灶,而未合并认知功能障碍组未发现异常信号。合并认知功能障碍组左侧额叶、右侧额叶、左侧颞叶、右侧颞叶、左侧基底节区、右侧基底节区、半卵圆中心FA值均明显低于未合并功能障碍组(P<0.05),而上述部位ADC值均明显高于未合并认知功能障碍组(P<0.05)。SLE合并认知功能障碍患者的额叶、颞叶、基底节区、半卵圆中心FA值与MoCA评分均呈正相关,而上述部位ADC值与MoCA评分均呈负相关(P<0.05)。合并认知功能障碍组受教育年限≥12年的患者比例明显低于未合并认知功能障碍组,而神经精神性系统性红斑狼疮(NPSLE)的患者比例明显高于未合并认知功能障碍组(P<0.05)。多因素Logistic回归分析显示,NPSLE是SLE患者合并认知功能障碍的危险因素,受教育年限≥12年是SLE患者合并认知功能障碍的保护因素(P<0.05)。结论:DTI技术对SLE合并认知功能障碍具有一定诊断价值,是否为NPSLE以及受教育程度会影响SLE患者的认知功能障碍发生风险,值得临床关注。Objective:To investigate the diagnostic value of diffusion tensor imaging(DTI) in patients with systemic lupus erythematosus(SLE) complicated with cognitive impairment,and to analyze the risk factors of cognitive impairment in SLE.Methods:92 SLE patients who were treated in Hebei Provincial People’s Hospital from January 2012 to March 2022 were selected,according to the evaluation results of Montreal cognitive function assessment scale(MoCA),they were divided into the group with cognitive impairment(MoCA score < 26 scores,35 cases) and the group without cognitive impairment(MoCA score ≥ 26 scores,57 cases).The results of conventional magnetic resonance and DTI were compared between the two groups,and the correlation between fractionalanisotrop score(FA),apparent diffusion coefficient(ADC) and MOCA score were analyzed.Multivariate Logistic regression was used to analyze the risk factors of cognitive impairment in SLE.Results:Routine magnetic resonance examination showed that 14 patients in the group with cognitive impairment had abnormal signal foci,while no abnormal signal was found in the group without cognitive impairment.The FA values of left frontal lobe,right frontal lobe,left temporal lobe,right temporal lobe,left basal ganglia,right basal ganglia and semioval center in the group with cognitive impairment were significantly lower than those in the group without cognitive impairment(P<0.05),while the ADC values of the above parts were significantly higher than those in the group without cognitive impairment(P<0.05).FA values in frontal lobe,temporal lobe,basal ganglia and semioval center of SLE patients with cognitive impairment were positively correlated with MOCA score,while ADC values in these parts were negatively correlated with MOCA score(P<0.05).The proportion of patients with years of education ≥12 years in the group with cognitive impairment was significantly lower than that in the group without cognitive impairment,while the proportion of patients with neuropsychiatric systemic lupus erythema

关 键 词：弥散张量成像技术 系统性红斑狼疮 认知功能 诊断价值 危险因素 

分 类 号：R593.24[医药卫生—内科学] R445[医药卫生—临床医学]