不宁腿综合征脑铁代谢的变化

发布时间：2018-06-23 03:20

  本文选题：不宁腿综合征 + 多回波采集的增强T2~*加权血管成像　； 参考：《南昌大学》2014年硕士论文

【摘要】：目的：了解不宁腿综合征(restlesslegssyndrome,RLS)患者脑铁代谢的变化，探讨RLS的发病机制及其临床特征。 方法：采用3.0TMR系统对RLS患者和年龄、性别相匹配的健康志愿者分别进行常规序列、多回波采集的增强T2*加权血管成像（enhancedT2-starweightedangiography,ESWAN）序列的颅脑扫描，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ANCOVA方法对两组之间的脑铁含量进行统计分析。 结果：35例RLS患者及35例年龄、性别相匹配的健康志愿者被纳入本项研究。RLS患者和健康志愿者右侧感兴趣区的脑铁含量多低于左侧，，但左右两侧差异无明显统计学意义（P0.05）。RLS患者脑内双侧感兴趣区的铁含量明显低于健康对照者，尤其是红核（F=8.372，P=0.005）、黑质致密部（F=8.741，P=0.004）、黑质网状部（F=6.525，P=0.013）、苍白球（F=6.275，P=0.015）、丘脑（F=5.084，P=0.027）、齿状核（F=5.080，P=0.027）的铁含量减少有显著统计学意义，并且与不宁腿综合征严重程度量表评分呈负相关。重度RLS患者脑铁含量较轻中度RLS及健康对照者明显降低（F=3.859,P=0.026到F=30.238,P=0.000）。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≥45ug/l组或45ug/l组的RLS患者与健康对照组比较，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≥45ug/l组与45ug/l组间比较，除苍白球外，所有感兴趣区的脑铁含量差异无显著性（P0.05）。ESWAN技术对于脑铁含量的检测具有较高的诊断价值，丘脑区ROC曲线下面积为0.949，其敏感性和特异性分别为100%、76.2%。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患者的脑铁含量与不宁腿综合征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。ESWAN技术有可能成为RLS患者临床评估的重要方法。
[Abstract]:Objective: to investigate the changes of brain iron metabolism in patients with restless legs syndrome (RLS) and to explore the pathogenesis and clinical features of RLS. Methods: a 3.0TMR system was used to scan the brain of RLS patients and healthy volunteers matched by age and sex. The enhanced T2 * weighted angiography (ESWAN) sequences were obtained by multi-echo imaging. The regions of interest included the nucleus erythema and the dense part of substantia nigra. The brain iron content in the substantia nigra reticular part, thalamus, globus pallidus, putamen nucleus, caudate nucleus head, dentate nucleus and cerebrospinal fluid was analyzed by ANCOVA method. Results in this study, 35 RLS patients with RLS and 35 healthy volunteers with age and sex matched were included in this study. The brain iron content in the right region of interest of RLS patients and healthy volunteers was lower than that in the left side. However, there was no significant difference between left and right sides (P0.05). The iron content in bilateral regions of interest in RLS patients was significantly lower than that in healthy controls. In particular, the reduction of iron content in the nucleus rubrum (FV 8.372), the dense part of the substantia nigra (P0. 004), the reticular part of the substantia nigra (FN 6. 525), the globus pallidus (FN 6. 275), the thalamus (FN 5. 084P0. 027) and the dentate nucleus (F5. 080 P0. 027) had significant statistical significance. The content of brain iron in patients with severe RLS was significantly lower than that in patients with mild and moderate RLS and healthy controls (F0. 859%, P < 0. 026, F = 30. 238, P < 0. 000). The changes of serum ferritin were not consistent with the changes of brain iron metabolism, although the serum ferritin 鈮

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