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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (01) : 48 -53. doi: 10.3877/cma.j.issn.1674-6902.2020.01.010

论著

应用基于体素的形态学测量在不同程度OSAHS脑灰质密度变化的研究
拉周措毛1, 关巍1, 秦棕园2, 王丽飞1, 冯喜英1,†()   
  1. 1. 810000　西宁，青海大学附属医院呼吸科
    2. 810000　西宁，青海大学附属医院影像中心
  • 收稿日期:2019-06-18 出版日期:2020-02-25
  • 通信作者: 冯喜英
  • 基金资助:
    青海大学附属医院中青年科研基金一般项目(ASRF-2015-YB-05)

Gray matter volume alterations in patients with obstructive sleep apnea hypopnea syndrome by using voxel-based morphometry of magnetic resonance imaging

Cuomao Lazhou1, Wei Guan1, Zongyuan Qin2, Lifei Wang1, Xiying Feng1,†()   

  1. 1. Department of Respiratory Medicine, Affiliated Hospital of Qinghai University, Xining 810000, China
    2. Image Centre, Affiliated Hospital of Qinghai University, Xining 810000, China
  • Received:2019-06-18 Published:2020-02-25
  • Corresponding author: Xiying Feng
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拉周措毛, 关巍, 秦棕园, 王丽飞, 冯喜英. 应用基于体素的形态学测量在不同程度OSAHS脑灰质密度变化的研究[J/OL]. 中华肺部疾病杂志(电子版), 2020, 13(01): 48-53.

Cuomao Lazhou, Wei Guan, Zongyuan Qin, Lifei Wang, Xiying Feng. Gray matter volume alterations in patients with obstructive sleep apnea hypopnea syndrome by using voxel-based morphometry of magnetic resonance imaging[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(01): 48-53.

目的

应用基于体素的形态学测量(VBM)技术初步探讨不同程度的OSAHS对大脑微观结构的影响。

方法

应用PHILIPS 3.0 T磁共振对通过脑MRI-VBM技术比较研究2016年1月至2017年12月我院确诊的轻、中、重度OSAHS患者的脑结构变化情况。

结果

①本研究对55例确诊的OSAHS患者依据睡眠呼吸暂停低通气指数(AHI)将其分为轻、中、重度，各组间年龄、性别及海拔无明显差异(均P>0.05)，轻度组平均血氧饱和度(MSpO2)、最低氧饱和度(LSpO2)均明显高于中度、重度组(P<0.05)，重度OSAHS组AHI显著高于轻度、中度组(P＝0.000); ②中度OSAHS患者与轻度OSAHS患者VBM-MRI相比较，包括左侧杏仁核、左侧海马、左侧脑岛脑灰质体积减少；③重度OSAHS患者与轻度OSAHS患者VBM-MRI相比较，右侧海马旁回脑灰质体积减少；④重度OSAHS患者与中度OSAHS患者VBM-MRI相比较：包括左侧脑岛、左侧尾状核、左侧豆状壳核脑灰质体积增加；左侧丘脑、右侧丘脑脑灰质体积减少。

结论

不同程度的OSAHS患者间歇缺氧下导致脑灰质有不同程度的变化，说明了OSAHS对患者的脑结构有着一定程度的影响。

关键词: 低通气综合征, 睡眠呼吸暂停, 阻塞性, 磁共振成像, 脑灰质
Objective

To investigate the gray matter volumes (GMV) alterations in the patients with obstructive sleep apnea hypopnea syndrome (OSAHS) by using voxel-based morphometry (VBM) of magnetic resonance imaging (MRI).

Methods

A total of 55 OSAHS patients who were diagnosed by polysomnography (PSG) in the Affiliated Hospital of Qinghai University from January 2016 to December 2017 were enrolled for this study. According to the apnea hypopnea index (AHI), they were divided into a mild group, a moderate group and a severe group. These groups were matched with the altitude, age, gender and residential elevation. Then we used the VBM to compare the whole brain GMV among the mild group, moderate group and severe group.

Results

①No significant difference was found in the altitude, age, gender and residential elevation among the groups (P>0.05). The mean oxygen saturation in the mild group was higher than those of the moderate group and the severe group (P<0.05) and the AHI in the severe group was higher than those of the mild group and the moderate group (P=0.000). ②The volumes of the left amygdala, left hippocampal and left insular gray matter in the patients with moderate OSAHS were decreased compared with those in the mild patients. ③The volume of the right parahippocampal gray matter was decreased in the severe OSAHS patients compared with the mild patients. ④The volumes of the left caudate nucleus and left-sided putamen gray matter in the patients with severe OSAHS were increased, and bilateral thalamic volume was reduced compared with the moderate group.

Conclusion

The changes of brain regions of different degrees of OSAHS patients′gray matter volumes were different, which indicates that different degrees of OSAHS may affect different brain structures.

Key words: Obstructive sleep apnea hypopnea syndrome, Gray matter, Voxel-based morphometry
表1 OSAHS患者一般资料及PSG参数比较
组　别 例数 AHI (次/h) MSpO2 (%) LSpO2(%)
轻度组 10 9.3(7.6，10.2) 90.0(87.0，93.2) 85.0(78.5，87.0)
中度组 11 20.6(18.3，27.0)a 85.0(82.0，85.0)a 67.0(62.0，75.0)a
重度组 34 58.8(43.0，76.8)ab 85.5(83.0，90.0)a 68.5(53.2，73.2)ab
Z值   59.963 32.369 40.418
P值   0.000 0.000 0.000
图1 中度OSAHS组与轻度OSAHS组相比灰质体积有差异的脑区统计参数图1；注：蓝色代表中度OSAHS患者较轻度OSAHS患者灰质体积减少的脑区，包括左侧杏仁核、左侧海马、左侧脑岛脑灰质体积减少。(统计阈值设为P<0.05，cluster size>389，Alphasim校正)
表2 中度组与轻度组患者脑灰质体积变化
脑　区 体素 MNI坐标 t值
X Y Z
Amygdala_L (aal)左侧杏仁核 46 -20 -2 -12 -4.9951
Hippocampus_L (aal)左侧海马 123 -31 -34 -8 -3.0745
Insula_L (aal)左侧脑岛 95 -39 0 -10 -2.1559
图2 重度OSAHS组与轻度OSAHS组相比灰质体积有差异的脑区统计参数图；注：蓝色代表重度OSAHS患者较轻度OSAHS患者灰质体积减少的脑区，主要以右侧海马旁回脑灰质体积减少为著，(统计阈值设为P<0.05，cluster size>389，Alphasim校正)
表3 重度组与轻度组患者脑灰质体积变化
脑　区 体素 MNI坐标 t值
X Y Z
ParaHippocampal_R (aal)右侧海马旁回 63 24 -32 -14 -4.2198
图3 重度OSAHS组与中度OSAHS组相比灰质体积有差异的脑区统计参数；注：红色代表重度OSAHSA组较中度OSAHS组灰质体积增加的脑区，包括左侧脑岛、左侧尾状核、左侧豆状壳核；蓝色代表重度OSAHS患者较中度OSAHS患者灰质体积减少的脑区，包括左侧丘脑、右侧丘脑。(统计阈值设为P<0.05，cluster size>389，Alphasim校正)
表4 重度组与中度组患者脑灰质体积变化
脑区 体素 MNI坐标 t值
X Y Z
Insula_L (aal)左侧脑岛 156 -38 -2 -8 4.2369
Caudate_L (aal)左侧尾状核 90 -8 11 0 2.2712
Thalamus_L (aal)左侧丘脑 145 -11 -24 1 -3.2469
Thalamus_R (aal)右侧丘脑 168 12 -25 2 -3.7969
Putamen_L (aal)左侧豆状壳核 127 -23 2 -9 3.3050
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