基于DTI-ALPS指数分析不同亚型发作性睡病患者类淋巴系统功能改变  

Analysis of changes in glymphatic system function in different types of narcolepsy patients based on theDTI-ALPS index

作　　者：胡鹏鑫 邹宇 袁于青 熊瑞芳 李承毅 朱涵婷 周明玉 谢亮[2] 唐小平[1,3] HU Peng-xin;ZOU Yu;YUAN Yu-qing(Medical Imaging Center/Jiangxi Key Laboratory of Intelligent Medical Imaging,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院医学影像中心/江西省智能医学影像重点实验室,南昌330006 [2]南昌大学第二附属医院神经内科,南昌330006 [3]清华大学国家卓越工程师学院,北京100084

出　　处：《放射学实践》2025年第3期295-301,共7页Radiologic Practice

基　　金：江西省自然科学基金资助项目(20232BAB206132)。

摘　　要：目的:基于血管周围间隙扩散张量成像(DTI-ALPS)分析不同亚型发作性睡病(NT)患者的类淋巴系统功能改变及其与临床参数的关系,并进一步探讨类淋巴系统系统功能指标区分不同亚型NT的价值。方法:收集2022年9月-2024年2月在南昌大学第二附属医院确诊的31名1型发作性睡病(NT1)和15名2型发作性睡病(NT2)患者及年龄性别相匹配的30名健康对照者(HC)。受试者进行Epworth嗜睡量表(ESS)、匹兹堡睡眠质量指数量表(PSQI)评分,所有NT患者均进行多导睡眠监测和多次睡眠潜伏期实验,记录平均睡眠潜伏期时间和始发快速眼动期睡眠(SOREMP)次数及N1期、N2期、N3期睡眠占比等相关参数。所有受试者的DTI图像使用DSI-Studio软件处理并计算双侧DTI-ALPS指数。比较不同组间受试者临床资料,采用单因素方差分析不同组间的双侧DTI-ALPS指数的差异,采用受试者操作特征(ROC)曲线评估双侧DTI-ALSP指数区分NT1和NT2患者的诊断价值。为控制年龄和性别的影响,采用偏相关性分析NT患者双侧DTI-ALPS指数与临床参数的相关性。结果:NT1组的ESS评分、PSQI评分显著高于NT2组和HC组(P<0.05),NT1组双侧DTI-ALPS指数(左:1.412±0.137;右:1.398±0.152)显著低于NT2组(左:1.608±0.106;右:1.586±0.067)和HC组(左:1.632±0.159;右:1.660±0.181)(P<0.001)。NT患者DTI-ALPS指数与N2期、N3期占比呈正相关(P<0.05),与ESS评分、N1期占比、SOREMP次数呈负相关(P<0.05)。双侧DTI-ALPS指数对区分NT1和NT2患者具有较好的诊断效能,临界值分别为1.528、1.524,AUC分别为0.899、0.839。结论:NT患者存在类淋巴系统功能障碍,且NT1患者更为严重,NT患者类淋巴系统功能障碍与其睡眠结构紊乱有关。DTI-ALPS指数区分不同亚型NT患者具有较好的诊断效能。Objective:The purposes of this study were to investigate the changes in glymphatic system function in different types of narcolepsy(NT)patients and their relationship with clinical parameters based on diffusion tensor imaging along perivascular space(DTI-ALPS)index,and to futher discuss the value of classifying the glymphatic system function indexes among different subtypes of NT.Methods:A total of 31 patients with narcolepsy type 1(NT1)and 15 with narcolepsy type 2(NT2)diagnosed at the Second Affiliated Hospital of Nanchang University from September 2022 to February 2024 and 30 age-and gender-matched healthy controls(HC)were recruited.The participants were assessed using the Epworth Sleepiness Scale(ESS)and the Pittsburgh Sleep Quality Index(PSQI).All NT patients underwent polysomnography and multiple sleep latency tests,the mean sleep latency time,the number of sleep onset REM periods(SOREMP),and the percentage of N1,N2,N3,and REM sleep stages were recorded.The DTI images of all subjects were processed using DSI-Studio software and the bilateral DTI-ALPS index was calculated.The clinical data of the participants from different groups were compared,and ANOVA was used to assess the differences in the DTI-ALPS index between the groups.Receiver operating characteristics(ROC)curves were used to evaluate the diagnostic value of the DTI-ALSP index in distinguishing NT1 from NT2 patients.A partial correlation analysis was conducted to assess the correlation between bilateral DTI-ALPS indices and clinical parameters in NT patients to control the influence of age and gender.Results:In the NT1 group,the ESS and PSQI scores were significantly higher than those in the NT2 and HC groups(P<0.05).The bilateral DTI-ALPS index in the NT1 group(left:1.412±0.137;right:1.398±1.398)were significantly lower than those in the NT2 group(left:1.608±0.106;right:1.586±0.067)and HC group(left:1.632±0.159;right:1.660±0.181)(P<0.001).The DTI-ALPS in NT patients showed a positive correlation with N2 stage and N3 stage percentages(P<0.05

关 键 词：发作性睡病 类淋巴系统 血管周围间隙 磁共振成像 扩散张量成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R742.89[医药卫生—诊断学]