CAJ | 학술논문

目的探讨原发性开角型青光眼(POAG)患者大脑相关皮层的形态学变化,为深入研究POAG的中枢损害机制提供依据.方法 2011年2月至2012年12月复旦大学附属华山医院眼科门诊就诊并确诊为POAG的患者30例,年龄26 ～ 82岁,男19例,女11例,选取与POAG患者年龄、性别相匹配的健康志愿者30名作为对照组.所有受试者都进行常规眼科检查.磁共振成像(MRI)检查使用Siemens Magneton Verio 3T MRI,采用12通道头部线圈,常规T1WI、T2WI及液体衰减反转恢复(FLAIR)扫描检查,确认受试者头颅无占位性及血管性等病变后纳入研究.全脑三维容积数据采用三维磁化强度预备梯度回波序列(3D-MPRAGE).影像数据处理与统计分析使用SPM8及VBM8软件在Matlab 2012a平台上进行,处理过程包括脑的空间标准化、灰白质分割及空间平滑.POAG组和对照组的全脑灰质图像采用基于体素的形态学分析方法(VBM)进行统计学分析.本研究通过复旦大学附属华山医院伦理委员会批准.结果与对照组相比,POAG组患者存在多个脑区的灰质体积减小,主要表现在枕叶(左舌回,t=3.207,P=0.002)、额叶(左额内侧回,t=2.912,P=0.004;右额上回,t=2.745,P=0.005)、颞叶(左颞中回,t=2.958,P=0.003)、顶叶(右楔前叶,t=3.291,P=0.001;右中央后回,t=3.306,P=0.001;左顶下小叶,t=2.716,P=0.006)、边缘叶(左海马回,t=2.815,P=0.005)等脑区.结果采用配对t检验,当t＞2.479时,P＜0.01,POAG组与对照组比较差异有统计学意义.结论 POAG患者的大脑皮层存在多区域的灰质体积的减少,印证了POAG是在大脑多方面、多层次造成损伤的综合征,除视觉通路损伤外,其他脑区也存在形态及功能的改变.
목적 탐토원발성개각형청광안(POAG)환자대뇌상관피층적형태학변화,위심입연구POAG적중추손해궤제제공의거.방법 2011년2월지2012년12월복단대학부속화산의원안과문진취진병학진위POAG적환자30례,년령26 ～ 82세,남19례,녀11례,선취여POAG환자년령、성별상필배적건강지원자30명작위대조조.소유수시자도진행상규안과검사.자공진성상(MRI)검사사용Siemens Magneton Verio 3T MRI,채용12통도두부선권,상규T1WI、T2WI급액체쇠감반전회복(FLAIR)소묘검사,학인수시자두로무점위성급혈관성등병변후납입연구.전뇌삼유용적수거채용삼유자화강도예비제도회파서렬(3D-MPRAGE).영상수거처리여통계분석사용SPM8급VBM8연건재Matlab 2012a평태상진행,처리과정포괄뇌적공간표준화、회백질분할급공간평활.POAG조화대조조적전뇌회질도상채용기우체소적형태학분석방법(VBM)진행통계학분석.본연구통과복단대학부속화산의원윤리위원회비준.결과 여대조조상비,POAG조환자존재다개뇌구적회질체적감소,주요표현재침협(좌설회,t=3.207,P=0.002)、액협(좌액내측회,t=2.912,P=0.004;우액상회,t=2.745,P=0.005)、섭협(좌섭중회,t=2.958,P=0.003)、정협(우설전협,t=3.291,P=0.001;우중앙후회,t=3.306,P=0.001;좌정하소협,t=2.716,P=0.006)、변연협(좌해마회,t=2.815,P=0.005)등뇌구.결과채용배대t검험,당t＞2.479시,P＜0.01,POAG조여대조조비교차이유통계학의의.결론 POAG환자적대뇌피층존재다구역적회질체적적감소,인증료POAG시재대뇌다방면、다층차조성손상적종합정,제시각통로손상외,기타뇌구야존재형태급공능적개변.
Objective To observe the morphology changes of cerebral cortex in primary open-angle glaucoma (POAG) patients,and to explore the damage mechanism in the central nerve system.Methods 30 patients,19 males and 11 females (age ranged from 26 to 82 years old),who were diagnosed with POAG in the department of ophthalmology at Huashan Hospital of Fudan University from February 2011 to December 2012 were enrolled.Meanwhile,additional 30 age-and sex-matched patients were collected as controls.All subjects underwent a complete ophthalmic evaluation.As for magnetic resonance imaging (MRI),we adopted the scans of T1WI,T2WI and fluid attenuated inversion recovery (FLAIR) on a Siemens Magneton Verio 3T MRI machine with a 12-channel head coil.Subjects with space occupying or vascular lesion in brain imaging were excluded from the study.The three-dimensional magnetization prepared rapid acquisition gradient echo sequence (3D-MPRAGE) was used to acquire the volume data of whole brain of all subjects.SPM8 and VBM8 toolbox were used to analyze the image data.Voxel-based analysis was done for whole brain grey matter images.Results Compared with the control group,the volume of grey matter from several brain regions of the POAG patients decreased.These structures included left lingual gyrus (t =3.207,P =0.002),left medial frontal gyrus (t =2.912,P =0.004),right superior frontal gyrus (t =2.745,P =0.005),left middle temporal gyrus (t =2.958,P =0.003),right precuneus (t =3.291,P =0.001),right postcentral gyrus (t =3.306,P =0.001),left inferior parietal lobule (t =2.716,P =0.006),left parahippocampa gyrus (t =2.815,P =0.005).The results were assessed with comparative t-test to perform statistical analysis.When t ＞ 2.479,P ＜ 0.01,the difference between the two groups was considered statistically significant.Conclusion The volume of grey matter in POAG patients' brain decreased in several regions.It is illustrated that POAG is a syndrome,which causes damages in the brain of POAG patients at multi-aspects and multi-levels.The damages contained not only injuries in the visual pathway,but also morphological and functional changes in many other brain regions.