【摘要】 目的通过分析重度阻塞性睡眠呼吸暂停综合征(OSAS)患者脑部功能磁共振成像(fMRI)参数变化,探讨三维动脉自旋标记(3D-ASL)联合磁共振波谱(1H-MRS)评价患者早期脑组织改变的应用价值。方法对2015年12月至2019年12月湖州市中心医院83例临床确诊的重度OSAS患者[呼吸暂停低通气指数(AHI)>30次/h]和83例无OSAS表现的健康体检者(AHI<5次/h),头部分别进行3D-ASL、弥散张量成像(DTI)及~1H-MRS检查,测量右侧额叶白质、右侧扣带回脑血流量(CBF)、各向异性(FA)值、表观弥散系数(ADC)、N-乙酰天门冬氨酸/胆碱(NAA/Cho)、胆碱/肌酸(Cho/Cr)值,对两组fMRI成像参数进行统计分析,对预测指标进行ROC曲线分析并计算AUC、灵敏度、特异度、最佳临界值。结果重度OSAS患者右侧额叶白质CBF、FA、ADC、NAA/Cho与健康对照组比较差异均有统计学意义(均P<0.05),AUC分别为0.865、0.863、0.826、0.993,提示NAA/Cho是诊断脑白质改变的最优参数,其最佳临界值为1.390,灵敏度为0.967,特异度为0.967;重度OSAS患者右侧额叶扣带回CBF、ADC、NAA/Cho、Cho/Cr与健康对照组比较差异均有统计学意义(均P<0.05),AUC分别为0.950、0.815、0.921、0.897,提示CBF是诊断脑灰质改变的最优参数,其最佳临界值为39.63 ml/(min·100 g),灵敏度为0.917,特异度为0.817。结论 3D-ASL联合~1H-MRS有助于全面判断重度OSAS患者早期脑组织改变,对临床早期干预和判断预后具有重要参考价值。更多还原

【Abstract】 Objective To assess the value of functional MRI(fMRI) parameters in evaluation of early cerebral damage in patients with severe obstructive sleep apnea syndrome(OSAS). Methods The fMRI scans, including 3D-ASL, DTI and ~1H-MRS examinations were performed in 83 patients with severe OSAS and in 83 age-matched control subjects. Cerebral blood flow(CBF), fractional anisotropy(FA), apparent diffusion coefficient(ADC), NAA/Cho, Cho/Cr were measured in right white matter of frontal lobe and right cingulae gyrus. Independent samples t test was used for statistical analysis; receiver operator characteristic curve(ROC) analysis of the prediction indexes were performed, and the optimum parameter and its diagnostic threshold were identified. Results There were significant differences in values of CBF, FA, ADC and NAA/Cho in white matter of the right frontal lobe between OSAS patients and healthy controls(all P<0.05). The areas under the ROC curves(AUCs) of above parameters in predicting white matter injury of OSAS patients were 0.865, 0.863, 0.826 and 0.993, respectively. The NAA/Cho had best diagnostic value for white matter injury; taken 1.390 as cut-off value, the sensitivity and specificity was 0.967 and 0.967, respectively.There were significant differences in values of CBF, ADC, NAA/Cho and Cho/Cr in cingulate gyrus of the right frontal lobe between OSAS patients and healthy subjects(all P<0.05). The AUCs of above parameters for diagnosis were 0.950, 0.815, 0.921 and 0.897, respectively. The CBF had best diagnostic value for the injury to cerebral cortex; and taken 39.63 ml/(min·100 g) as diagnosis threshold, the sensitivity and specificity was 0.917 and 0.817, respectively. Conclusion The combination of 3D-ASL and ~1H-MRS may be used for comprehensive diagnosis of early cerebral injury in patients with severe OSAS.更多还原