CAJ | 학술논문

目的：运用扩散张量成像(DTI)技术探讨复发-缓解型多发性硬化(RRMS)和复发型视神经脊髓炎(RNMO)患者看似正常视放射区DTI指标是否存在差异。材料与方法 RRMS患者、RNMO患者及年龄与性别相匹配的健康志愿者各20例行DTI检查，分别测量双侧视放射的FA值及MD值，并采用扩展残疾状态量表(EDSS)对两组患者进行评分。应用SPSS 17.0配对t检验、单因素方差分析及Dunnett-t检验分别分析患者组及健康对照组组内及组间两侧视放射的FA值及MD值，以及用Spearman软件分析DTI定量值与EDSS评分的相关性。结果(1)健康对照组、RRMS及RNMO患者组组内双侧视放射FA值(t=0.41，P=0.68；t=0.10， P=0.92；t=0.63，P=0.54)及MD值(t=0.72，P=0.48；t=0.20，P=0.84；t=0.20， P=0.84)均没有明显差异(P＞0.05)；RRMS及RNMO患者组左右两侧视放射FA值(P=0.00；P=0.00)均比健康对照组显著下降，MD值(P=0.00；P=0.00)均比健康对照组显著升高(P＜0.05)；RNMO组双侧视放射FA值比RRMS组下降(P=0.02)，而MD值(P=0.50)无明显差别；(2) RRMS组及RNMO组双侧视放射FA值(r=－0.19， P=0.42；r=0.20，P=0.41)及MD值(r=0.11，P=0.64；r=－0.33，P=0.15)与EDSS评分均没有明显的相关性(P＞0.05)。结论 RRMS及RNMO患者看似正常的视放射区均有受累，但二者视放射受累的程度不一致，FA值对鉴别MS及NMO具有潜在的应用价值，并可作为监测MS及NMO临床进展的重要生物学指标。
목적：운용확산장량성상(DTI)기술탐토복발-완해형다발성경화(RRMS)화복발형시신경척수염(RNMO)환자간사정상시방사구DTI지표시부존재차이。재료여방법 RRMS환자、RNMO환자급년령여성별상필배적건강지원자각20례행DTI검사，분별측량쌍측시방사적FA치급MD치，병채용확전잔질상태량표(EDSS)대량조환자진행평분。응용SPSS 17.0배대t검험、단인소방차분석급Dunnett-t검험분별분석환자조급건강대조조조내급조간량측시방사적FA치급MD치，이급용Spearman연건분석DTI정량치여EDSS평분적상관성。결과(1)건강대조조、RRMS급RNMO환자조조내쌍측시방사FA치(t=0.41，P=0.68；t=0.10， P=0.92；t=0.63，P=0.54)급MD치(t=0.72，P=0.48；t=0.20，P=0.84；t=0.20， P=0.84)균몰유명현차이(P＞0.05)；RRMS급RNMO환자조좌우량측시방사FA치(P=0.00；P=0.00)균비건강대조조현저하강，MD치(P=0.00；P=0.00)균비건강대조조현저승고(P＜0.05)；RNMO조쌍측시방사FA치비RRMS조하강(P=0.02)，이MD치(P=0.50)무명현차별；(2) RRMS조급RNMO조쌍측시방사FA치(r=－0.19， P=0.42；r=0.20，P=0.41)급MD치(r=0.11，P=0.64；r=－0.33，P=0.15)여EDSS평분균몰유명현적상관성(P＞0.05)。결론 RRMS급RNMO환자간사정상적시방사구균유수루，단이자시방사수루적정도불일치，FA치대감별MS급NMO구유잠재적응용개치，병가작위감측MS급NMO림상진전적중요생물학지표。
Objective: To investigate whether there are differences in diffusion tensor imaging (DTI) indexes between relapsing-remitting multiple sclerosis (RRMS) and relapsing neuromyelitis optica (RNMO) in the apparent normal optic radiation by DTI. Materials and Methods: Twenty cases RRMS and RNMO patients and 20 cases age- and sex- matched healthy volunteers received DTI. Fractional anisotropy (FA) value and mean diffusivity (MD) value were acquired on bilateral optic radiation individually, and all RRMS and RNMO patients were evaluated by the expanded disability status scale (EDSS). We compared FA and MD value of bilateral optic radiation in each group usingt test. We compared FA and MD value of bilateral optic radiation between each patient group and normal control group using one-way analysis of variance (one-way ANOVA) andDunnett-t test. To evaluate the association between DTI value and EDSS score we usedSpearman. All statistical analyses were conducted using SPSS 17.0.Results:(1) In each group, The bilateral optic radiation FA value (t=0.41, P=0.68. t=0.10,P=0.92.t=0.63,P=0.54) and MD value (t=0.72,P=0.48.t=0.20,P=0.84.t=0.20, P=0.84) were not significantly different (P>0.05), respectively. FA value (P=0.00.P=0.00) of bilateral optic radiation in patient group was signiifcantly lower than normal control group, while MD value (P=0.00, P=0.00) was signiifcantly higher than normal control group (P<0.05). FA value (P=0.02) in RNMO patients was decreased than that of the RRMS patients, but the MD value (P=0.50) was not signiifcantly different. (2) There were not correlations between both FA (r=-0.19,P=0.42.r=0.20,P=0.41) and MD (r=0.11,P=0.64.r=-0.33,P=0.15) values of bilateral optic radiation and EDSS scores (P>0.05) in RRMS and RNMO.Conclusions:The appearing-normal optic radiation of both RRMS and RNMO patients was involved, but the involvement degree was not consistent in the two groups. FA value has potential applications to identify MS and NMO, as an important biological indicator for monitoring clinical course progress.