CAJ | 학술논문

目的利用fMRI视网膜皮层映射技术研究原发性开角型青光眼(POAG)患者V1区皮层功能变化.方法选取15例POAG患者及15名正常志愿者,利用视网膜皮层映射分区刺激和圆形黑白翻转棋盘格刺激采集fMRI数据.采用配对样本t检验比较POAG患者患侧眼与健侧眼V1区的fMRI反应、独立样本t检验比较健侧眼与匹配的正常人眼V1区的fMRI反应和激活.POAG患者患侧眼和健侧眼单独刺激时的V1皮层功能差异与视功能差异做线性相关分析.结果 (1)患侧眼接受刺激时V1区fMRI反应较健侧眼弱(t=4.757,P<0.01),患侧眼和健侧眼fMRI反应分别为(1.24±0.72)%、(2.18±0.93)%.患侧眼、健侧眼分别与其年龄、性别、眼侧别相匹配的正常人眼V1区fMRI反应进行比较:患侧眼较正常人眼反应弱(t=-3.011,P<0.01),患侧眼和匹配眼fMRI反应分别为(1.24±0.72)%、(2.01±0.65)%;健侧眼和匹配眼反应差异无统计学意义(t=0.742,P＞0.05),健侧眼和匹配眼分别为(2.18±0.93)%、(1.95±0.75)%.(2)患侧眼与健侧眼单独刺激的V1皮层功能差异与视功能差异存在线性负相关(r=-0.887,P<0.01).(3)患者的健侧眼与其年龄、性别、眼侧别相匹配的正常人眼比较,患者健侧眼V1激活较正常人眼小(t=-3.801,P<0.01),健侧眼和匹配眼V1激活面积指数分别为0.72±0.12、0.85±0.09.结论青光眼存在皮层功能损害,而且青光眼皮层功能的损害与视觉功能的损害存在相关一致性;基于fMRI视网膜皮层映射分区的定位、定量测量是一种对青光眼视觉皮层功能变化临床随访、评估测量的有用方法,也是活体人青光眼视觉通路跨突触退变研究的潜在有用工具.
목적 이용fMRI시망막피층영사기술연구원발성개각형청광안(POAG)환자V1구피층공능변화.방법 선취15례POAG환자급15명정상지원자,이용시망막피층영사분구자격화원형흑백번전기반격자격채집fMRI수거.채용배대양본t검험비교POAG환자환측안여건측안V1구적fMRI반응、독립양본t검험비교건측안여필배적정상인안V1구적fMRI반응화격활.POAG환자환측안화건측안단독자격시적V1피층공능차이여시공능차이주선성상관분석.결과 (1)환측안접수자격시V1구fMRI반응교건측안약(t=4.757,P<0.01),환측안화건측안fMRI반응분별위(1.24±0.72)%、(2.18±0.93)%.환측안、건측안분별여기년령、성별、안측별상필배적정상인안V1구fMRI반응진행비교:환측안교정상인안반응약(t=-3.011,P<0.01),환측안화필배안fMRI반응분별위(1.24±0.72)%、(2.01±0.65)%;건측안화필배안반응차이무통계학의의(t=0.742,P＞0.05),건측안화필배안분별위(2.18±0.93)%、(1.95±0.75)%.(2)환측안여건측안단독자격적V1피층공능차이여시공능차이존재선성부상관(r=-0.887,P<0.01).(3)환자적건측안여기년령、성별、안측별상필배적정상인안비교,환자건측안V1격활교정상인안소(t=-3.801,P<0.01),건측안화필배안V1격활면적지수분별위0.72±0.12、0.85±0.09.결론 청광안존재피층공능손해,이차청광안피층공능적손해여시각공능적손해존재상관일치성;기우fMRI시망막피층영사분구적정위、정량측량시일충대청광안시각피층공능변화림상수방、평고측량적유용방법,야시활체인청광안시각통로과돌촉퇴변연구적잠재유용공구.
Objective To evaluate the functional changes of visual cortex (V1) in patients with primary open angle glaucoma (POAG) by fMRI retinotopic mapping technology. Methods Fifteen POAG patients and 15 healthy volunteers underwent stimulations with fMRI retinotopic mapping stimulus and contrast-reversing checkerboard patterns stimulus on a Siemens Trio 3.0 T MRI whole-body scanner for functional data collection. Comparisons of V1 fMRI responses between the glaucomatous eyes and the healthy eyes of the patients were carried out using paired samples t-test, while independent samples t-test was used to compare V1 fMRI responses and activations between the healthy eyes of patients and the age-, gender- and side- matched eyes of normal people. Differences of V1 cortical functions and visual functions were analyzed by linear correlation analysis when the glaucomatous and the healthy eyes were simulated individually. Results (1) V1 fMRI responses of the individually stimulated glaucomatous eyes[(1.24±0.72)%]were weaker than those of the healthy eyes[(2.18±0.93)%](t=4.757,P<0.01). Comparisons of V1 fMRI responses between the glaucomatous eyes and matched eyes of normal people, as well as between the healthy eyes of patients and the matched eyes of normal people, were performed respectively: the responses in the glaucomatous eyes[(1.24±0.72)%]were weaker than those in the matched eyes of normal people[(2.01±0.65)%](t=-3.011,P<0.01). There was no statistical difference of the responses between the healthy eyes from patients[(2.18±0.93)%]and the matched eyes of normal people[(1.95±0.75)%](t=0.742,P＞0.05). (2) Differences of V1 cortical functions were negatively correlated with those of visual functions in the individually stimulated glaucomatous and healthy eyes (r=-0.887, P<0.01). (3) The activated area indexes of V1 cortexes in the healthy eyes from patients (0.72±0.12) were lower than those in the matched eyes of normal people (0.85±0.09) (t=-3.801, P<0.01). Conclusion Cortical function impairment was in accordance with visual function impairment in glaucoma. Located and quantified measurement with fMRI retinotopic mapping was a useful method for clinical follow-up and evaluation of functional alteration of glaucomatous visual cortex, and a potentially useful means of studying trans-synaptic degeneration of visual pathways of in vivo glaucoma.