目的 探讨不宁腿综合征患者脑铁代谢的变化.方法 连续收集2012年5月至2013年9月在南昌大学第二附属医院神经内科就诊的不宁腿综合征(RLS)患者35例和年龄、性别相匹配的健康志愿者35名.采用3.0T MR系统对RLS患者和健康志愿者进行多回波采集的增强T2加权血管成像(ESWAN)序列扫描,感兴趣区包括红核、黑质致密部、黑质网状部、丘脑、苍白球、壳核、尾状核头部、齿状核和脑脊液共9个部位,应用以年龄为协变量的协方差分析方法对两者之间的脑铁含量进行统计学分析.结果 RLS患者脑内双侧感兴趣区的铁含量明显低于健康对照者,尤其在红核(3.286±0.044与3.260±0.028,F=8.372,P=0.005)、黑质致密部(3.323±0.046与3.296±0.030,F=8.741,P=0.004)、黑质网状部(3.274±0.051与3.247±0.034,F=6.525,P=0.013)、苍白球(3.257±0.044与3.228±0.049,F=6.275,P=0.015)、丘脑(3.382±0.060与3.354±0.039,F =5.084,P=0.027)、齿状核(3.285±0.057与3.261±0.027,F=5.080,P=0.027)的铁含量减少差异有统计学意义,并且与RLS严重程度量表评分呈负相关(r=-0.836～-0.507,P=0.000～0.002).RLS患者右侧感兴趣区的脑铁含量低于左侧,但左右两侧差异无统计学意义.重度RLS患者的脑铁含量较轻中度RLS患者及健康对照者明显降低(F=3.859～ 30.238;P=0.000～ 0.026).血清铁蛋白的变化与脑铁代谢变化并不完全一致,虽然血清铁蛋白≥45 μg/L组和＜45 μg/L组与对照组比较,双侧苍白球(F=5.538,P=0.006)、黑质致密部(F=5.309,P=0.007)、黑质网状部(F=3.918,P=0.025)、红核(F =4.651,P=0.013)的铁含量明显降低,差异有统计学意义,但血清铁蛋白≥45 μg/L组与血清铁蛋白＜45 μg/L组比较,除苍白球外,所有感兴趣区脑铁含量差异均无统计学意义.结论 RLS患者脑铁含量明显降低,以红核、黑质、苍白球最为明显,病情严重时脑铁代谢异常的范围更广,并且RLS患者的脑铁含量与RLS严重程度量表评分呈负相关.血清铁蛋白测定在RLS诊治中的价值需进一步评估.
目的 探討不寧腿綜閤徵患者腦鐵代謝的變化.方法 連續收集2012年5月至2013年9月在南昌大學第二附屬醫院神經內科就診的不寧腿綜閤徵(RLS)患者35例和年齡、性彆相匹配的健康誌願者35名.採用3.0T MR繫統對RLS患者和健康誌願者進行多迴波採集的增彊T2加權血管成像(ESWAN)序列掃描,感興趣區包括紅覈、黑質緻密部、黑質網狀部、丘腦、蒼白毬、殼覈、尾狀覈頭部、齒狀覈和腦脊液共9箇部位,應用以年齡為協變量的協方差分析方法對兩者之間的腦鐵含量進行統計學分析.結果 RLS患者腦內雙側感興趣區的鐵含量明顯低于健康對照者,尤其在紅覈(3.286±0.044與3.260±0.028,F=8.372,P=0.005)、黑質緻密部(3.323±0.046與3.296±0.030,F=8.741,P=0.004)、黑質網狀部(3.274±0.051與3.247±0.034,F=6.525,P=0.013)、蒼白毬(3.257±0.044與3.228±0.049,F=6.275,P=0.015)、丘腦(3.382±0.060與3.354±0.039,F =5.084,P=0.027)、齒狀覈(3.285±0.057與3.261±0.027,F=5.080,P=0.027)的鐵含量減少差異有統計學意義,併且與RLS嚴重程度量錶評分呈負相關(r=-0.836～-0.507,P=0.000～0.002).RLS患者右側感興趣區的腦鐵含量低于左側,但左右兩側差異無統計學意義.重度RLS患者的腦鐵含量較輕中度RLS患者及健康對照者明顯降低(F=3.859～ 30.238;P=0.000～ 0.026).血清鐵蛋白的變化與腦鐵代謝變化併不完全一緻,雖然血清鐵蛋白≥45 μg/L組和＜45 μg/L組與對照組比較,雙側蒼白毬(F=5.538,P=0.006)、黑質緻密部(F=5.309,P=0.007)、黑質網狀部(F=3.918,P=0.025)、紅覈(F =4.651,P=0.013)的鐵含量明顯降低,差異有統計學意義,但血清鐵蛋白≥45 μg/L組與血清鐵蛋白＜45 μg/L組比較,除蒼白毬外,所有感興趣區腦鐵含量差異均無統計學意義.結論 RLS患者腦鐵含量明顯降低,以紅覈、黑質、蒼白毬最為明顯,病情嚴重時腦鐵代謝異常的範圍更廣,併且RLS患者的腦鐵含量與RLS嚴重程度量錶評分呈負相關.血清鐵蛋白測定在RLS診治中的價值需進一步評估.
목적 탐토불저퇴종합정환자뇌철대사적변화.방법 련속수집2012년5월지2013년9월재남창대학제이부속의원신경내과취진적불저퇴종합정(RLS)환자35례화년령、성별상필배적건강지원자35명.채용3.0T MR계통대RLS환자화건강지원자진행다회파채집적증강T2가권혈관성상(ESWAN)서렬소묘,감흥취구포괄홍핵、흑질치밀부、흑질망상부、구뇌、창백구、각핵、미상핵두부、치상핵화뇌척액공9개부위,응용이년령위협변량적협방차분석방법대량자지간적뇌철함량진행통계학분석.결과 RLS환자뇌내쌍측감흥취구적철함량명현저우건강대조자,우기재홍핵(3.286±0.044여3.260±0.028,F=8.372,P=0.005)、흑질치밀부(3.323±0.046여3.296±0.030,F=8.741,P=0.004)、흑질망상부(3.274±0.051여3.247±0.034,F=6.525,P=0.013)、창백구(3.257±0.044여3.228±0.049,F=6.275,P=0.015)、구뇌(3.382±0.060여3.354±0.039,F =5.084,P=0.027)、치상핵(3.285±0.057여3.261±0.027,F=5.080,P=0.027)적철함량감소차이유통계학의의,병차여RLS엄중정도량표평분정부상관(r=-0.836～-0.507,P=0.000～0.002).RLS환자우측감흥취구적뇌철함량저우좌측,단좌우량측차이무통계학의의.중도RLS환자적뇌철함량교경중도RLS환자급건강대조자명현강저(F=3.859～ 30.238;P=0.000～ 0.026).혈청철단백적변화여뇌철대사변화병불완전일치,수연혈청철단백≥45 μg/L조화＜45 μg/L조여대조조비교,쌍측창백구(F=5.538,P=0.006)、흑질치밀부(F=5.309,P=0.007)、흑질망상부(F=3.918,P=0.025)、홍핵(F =4.651,P=0.013)적철함량명현강저,차이유통계학의의,단혈청철단백≥45 μg/L조여혈청철단백＜45 μg/L조비교,제창백구외,소유감흥취구뇌철함량차이균무통계학의의.결론 RLS환자뇌철함량명현강저,이홍핵、흑질、창백구최위명현,병정엄중시뇌철대사이상적범위경엄,병차RLS환자적뇌철함량여RLS엄중정도량표평분정부상관.혈청철단백측정재RLS진치중적개치수진일보평고.
Objective To investigate the changes of brain iron metabolism in patients with restless legs syndrome (RLS).Methods Thirty-five patients with RLS and thirty-five sex-and age-matched healthy volunteers were consecutively collected in the Department of Neurology of the Second Affiliated Hospital of Nanchang University from May 2012 to Septemper 2013.Patients with RLS and healthy volunteers were analyzed on enhanced T2-star weighted angiography image (3.0 T),using region of interest (ROI) in red nucleus (RN),substantia nigra pars compacta (SNc),substantia nigra pars reticulata (SNr),thalamus (Th),globus pallidus (GP),putamen (PU),head of caudate nucleus (CN),dentate nucleus (DN),cerebrospinal fluid (CSF).The differences between the two groups were evaluated by analysis of covariance with age as a covariate.Results Brain iron content in the ROI was significantly lower in RLS patients compared with controls,such as RN (3.286 ± 0.044 vs 3.260 ± 0.028,F =8.372,P =0.005),SNc (3.323 ± 0.046 vs 3.296 ± 0.030,F =8.741,P =0.004),SNr (3.274 ± 0.051 vs 3.247 ± 0.034,F =6.525,P =0.013),GP (3.257 ±0.044 vs 3.228 ±0.049,F=6.275,P =0.015),Th (3.382-±0.060 vs 3.354 ±0.039,F=5.084,P =0.027) and DN (3.285 ±0.057 vs 3.261±0.027,F=5.080,P=0.027).There was a strong negative correlation between the iron content in the six regions (RN,SNc,SNr,GP,Th,DN) and International RLS Study Group Rating Scale (IRLS) score (ranging from r =-0.507,P =0.002 to r =-0.836,P =0.000).Brain iron content in the right ROI of RLS patients trended to be lower than that in the left,with no statistically significant difference.Brain iron content was significantly lower in the severe RLS group than either the mild-to-moderate group or controls (ranging from F =3.859,P =0.026 to F =30.238,P =0.000).Although brain iron content in GP (F =5.538,P =0.006),SNc (F =5.309,P =0.007),SNr (F =3.918,P =0.025) and RN (F =4.651,P =0.013) was significantly lower in RLS patients with either serum ferritin ≥ 45 μg/L or ＜ 45 μg/L,compared with controls,the change in serum ferritin level was not completely consistent with change of iron metabolism in brain.No significant difference was observed in the ROI (except GP) between the groups with serum ferritin ≥ 45 μg/L and ＜45 μg/L.Conclusions RLS patients present a low iron content in brain,especially in RN,SN and GP,with more regions involved in severer cases.There is a strong negative correlation between brain iron content and IRLS score.The value of serum ferritin in the diagnosis of RLS needs further evaluation.
