神经精神性狼疮患者脑灰质体积及功能连接异常的磁共振研究  

Magnetic resonance imaging study on gray matter volume and abnormal functional connectivity in patients with neuropsychiatric systemic lupus erythematosus

作　　者：李一凡 朱天逸 邹红梅 秦瑞琦 夏建国[1] 胡剑峰 张继 田为中 Li Yifan;Zhu Tianyi;Zou Hongmei;Qin Ruiqi;Xia Jianguo;Hu Jianfeng;Zhang Ji;Tian Weizhong(Department of Radiology,Affiliated Taizhou People's Hospital of Nanjing Medical University,Taizhou 225300,China;College of Health Science and Technology,School of Medicine,Shanghai Jiaotong University,Shanghai 200025,China;Department of Rheumatology and Immunology,Affiliated Taizhou People's Hospital of Nanjing Medical University,Taizhou 225300,China)

机构地区：[1]南京医科大学附属泰州人民医院影像科,泰州225300 [2]上海交通大学医学院医学技术学院,上海200025 [3]南京医科大学附属泰州人民医院风湿免疫科,泰州225300

出　　处：《中华神经医学杂志》2024年第11期1120-1128,共9页Chinese Journal of Neuromedicine

基　　金：江苏省卫健委科研课题(H2018093)。

摘　　要：目的通过基于体素的形态学测量(VBM)方法及静息态功能磁共振成像(rs-fMRI)中的功能连接(FC)分析方法,探讨神经精神性狼疮(NPSLE)患者影像学发病机制。方法收集自2020年6月至2023年3月在南京医科大学附属泰州人民医院风湿免疫科就诊的35例NPSLE患者(NPSLE组),30例非神经精神性狼疮(非NPSLE组)患者进入研究,同期纳入31例健康体检人员为健康对照(HC)组。3组受试者均完成常规MRI及rs-fMRI检查、实验室检查(C3、C4、IgA、IgM、IgG)及简易智力状态量表(MMSE)、医院焦虑抑郁量表(HADS)、运动和认知功能疲劳量表(FSMC)评分。通过VBM方法对3组受试者全脑灰质体积进行分析,并选择NPSLE组与非NPSLE组灰质体积差异脑区为感兴趣区(ROI)进行全脑FC分析。采用偏相关分析法检验NPSLE组与非NPSLE组差异脑区影像指标与临床指标、影像学评分之间的相关性。通过受试者工作特征曲线(ROC)分析差异脑区影像指标鉴别NPSLE与非NPSLE的效能。结果(1)3组受试者协方差分析结果显示,3组受试者左侧眶部额下回、左侧眶内额上回、右侧回直肌、右侧颞横回、右侧眶内额上回灰质体积差异有统计学意义(P<0.001,FDR校正);进一步两两比较结果显示,与HC组比,NPSLE组左侧眶部额下回、左侧眶内额上回、右侧回直肌、右侧颞横回、右侧眶内额上回灰质体积显著缩小,差异均有统计学意义(P<0.001,FDR校正)。与非NPSLE组比,NPSLE组左侧眶部额下回、右侧回直肌、右侧颞横回灰质体积显著减小,差异有统计学意义(P<0.001,FDR校正)。(2)以NPSLE组与非NPSLE组灰质体积差异脑区作种子点进行全脑FC分析发现,NPSLE组患者右侧颞横回与双侧中央后回标准化FC(zFC)值减低,差异有统计学意义(P<0.001,FDR校正)。(3)偏相关分析结果显示,NPSLE组右侧颞横回-左侧中央后回zFC值与病程呈负相关关系(r=-0.390,P=0.027);右侧眶内额上回灰质体积与FSMC-认知ObjectiveTo explore the pathogenesis of neuropsychiatric systemic lupus erythematosus(NPSLE)from imaging perspective by analyzing voxel-based morphology(VBM)and functional connectivity(FC)in resting state functional magnetic resonance imaging(rs-fMRI).MethodsThirty-five patients with NPSLE and 30 patients with non-NPSLE admitted to Department of Rheumatology and Immunology,Taizhou People's Hospital Affiliated to Nanjing Medical University from June 2020 to March 2023 were enrolled;31 healthy subjects were included as healthy control group during the same period.All subjects completed routine MRI and rs-fMRI,laboratory tests(C3,C4,IgA,IgM and IgG levels),mini-mental state examination(MMSE),hospital anxiety and depression scale(HADS),and fatigue scale for motor and cognitive functions(FSMC).Whole brain gray matter volume in subjects of the 3 groups was analyzed by VBM method,and the brain regions enjoying significant differences in gray matter volume between the NPSLE group and non-NPSLE group were selected as regions of interest(ROIs)for whole brain FC analysis.Partial correlation method was used to analyze the correlations of imaging indexes in brain regions enjoying significant differences with clinical indexes and imaging scores between NPSLE group and non-NPSLE group.Efficacy of imaging indexes in brain regions enjoying significant difference in differentiating NPSLE from non-NPSLE was analyzed by receiver operating characteristic(ROC)curve.Results(1)Covariance analysis among the 3 groups showed that the gray matter volume in the left inferior frontal gyrus of orbit,left superior frontal gyrus,right rectus gyrus,right transverse temporal gyrus,and right superior frontal gyrus was significantly different among the 3 groups(P<0.001,FDR corrected);compared with the healthy control group,the NPSLE group had significantly reduced gray matter volume in the left inferior frontal gyrus of orbit,left superior frontal gyrus of orbit,right rectus gyrus,right transverse temporal gyrus,and right superior frontal gyrus(P<0.

关 键 词：神经精神性狼疮 静息态功能磁共振成像 灰质体积 功能连接 差异脑区 

分 类 号：R445.2[医药卫生—影像医学与核医学] R593.24[医药卫生—诊断学] R747.9[医药卫生—临床医学]