CAJ | 학술논문

目的利用基于体素的形态测量学方法(VBM)评价肌萎缩侧索硬化(ALS)患者的脑灰质体积变化及其与临床特征之间的相关性.方法选取27例ALS患者和年龄、性别匹配的27名正常志愿者,采用VBM分析两组之间的全脑灰质体积和7个先验ROI:包括双侧中央前回,中央后回、额上、中、下回、额内侧回及岛叶灰质体积的改变；以P＜0.05[簇水平错误校正(FWE校正)]为差异有统计学意义.并使用偏相关分析,以年龄为控制因素,提取差异区域平均灰质密度与疾病严重程度评分、病程及疾病进展率进行相关性分析.结果全脑灰质体积比较显示左侧中央前回、左侧中央后回、左侧额上回局部灰质体积减少,差异有统计学意义(统计体素数目分别为388、112、127,Z值分别为4.83、4.09、6.42,P值均＜0.05,FWE校正).ROI分析显示左侧中央前回、右侧中央前回、左侧中央后回、左侧额上回和左侧岛叶灰质体积减少,差异有统计学意义(统计体素数目分别为1104、34、114、91、107,Z值分别为5.87、3.71、4.26、6.29、3.51,P值均＜0.05,FWE校正).所有局部灰质体积减少程度与各临床指标间未发现有统计学差异的线性关系.结论 ALS可出现运动皮层及非运动皮层多个脑区灰质体积减少,进一步证实ALS系一种多系统变性病.相对于全脑比较,ROI分析能敏感地揭示更广泛的脑区改变.VBM所揭示的结构改变与临床指标之间缺乏相关性,考虑与病情本身的异质性和方法学的敏感性有关.
목적 이용기우체소적형태측량학방법(VBM)평개기위축측색경화(ALS)환자적뇌회질체적변화급기여림상특정지간적상관성.방법 선취27례ALS환자화년령、성별필배적27명정상지원자,채용VBM분석량조지간적전뇌회질체적화7개선험ROI:포괄쌍측중앙전회,중앙후회、액상、중、하회、액내측회급도협회질체적적개변；이P＜0.05[족수평착오교정(FWE교정)]위차이유통계학의의.병사용편상관분석,이년령위공제인소,제취차이구역평균회질밀도여질병엄중정도평분、병정급질병진전솔진행상관성분석.결과 전뇌회질체적비교현시좌측중앙전회、좌측중앙후회、좌측액상회국부회질체적감소,차이유통계학의의(통계체소수목분별위388、112、127,Z치분별위4.83、4.09、6.42,P치균＜0.05,FWE교정).ROI분석현시좌측중앙전회、우측중앙전회、좌측중앙후회、좌측액상회화좌측도협회질체적감소,차이유통계학의의(통계체소수목분별위1104、34、114、91、107,Z치분별위5.87、3.71、4.26、6.29、3.51,P치균＜0.05,FWE교정).소유국부회질체적감소정도여각림상지표간미발현유통계학차이적선성관계.결론 ALS가출현운동피층급비운동피층다개뇌구회질체적감소,진일보증실ALS계일충다계통변성병.상대우전뇌비교,ROI분석능민감지게시경엄범적뇌구개변.VBM소게시적결구개변여림상지표지간결핍상관성,고필여병정본신적이질성화방법학적민감성유관.
Objective To evaluate the gray matter alterations in amyotrophic lateral sclerosis (ALS)by voxel-based morphometry (VBM),and further analyze the correlation between volume changes of gray matter and clinical characteristics.Methods Twenty-seven non-demented patients with ALS and 27 age and gender matched healthy controls were recruited.FSL-VBM was used to detect whole brain gray matter differences between the two groups.Seven prior ROIs were set to be analyzed,including bilateral precentral gyrus,postcentral gyrus,superior,medial,inferior,middle frontal gyrus,and insular cortex.The mean gray matter density of the ROIs was extracted in order to explore the correlation with several clinical measurements such as disease durations and disease severity scores,by using partial correlation analysis with age as covariates.Results Whole brain analysis showed significant gray matter loss in the left precentral gyrus,superior frontal gyrus and postcentral gyrus (numbers of voxel in clusters were 338,112,127,Z =4.83,4.09,6.42,P ＜0.05,FWE corrected).A prior seven ROIs analysis detected gray matter loss in the left precental gyrus,right precentral gyrus,left postcentral gyrus,superior frontal gyrus and left insular cortex (numbers of voxel in clusters were 1104,34,114,91,107,Z =5.87,3.71,4.26,6.29 and 3.51,P ＜0.05,FWE corrected).No statistical significant correlation between regional gray matter loss and clinical measurements were found.Conclusions Motor and extra-motor gray matter loss are present among patients with ALS,which demonstrates ALS as a multi-system disorder.In contrast to whole brain gray matter analysis,ROI analysis is more sensitive to detect extensive cortical changes.The heterogeneity of disease and sensitivity of method may contribute to the lack of correlation between gray matter volume decrease revealed by VBM and clinical characteristics.