摘要
目的:基于扩散张量成像血管周围间隙(DTI-APLS)指数分析,探讨慢性失眠患者脑类淋巴功能改变及其与睡眠状况(失眠年限和睡眠质量)的相关性。方法:回顾性分析21例慢性失眠患者和32例健康志愿者的常规DTI资料。在左侧大脑半球侧脑室体部水平的投射纤维区域、联合纤维区域勾画两个体素边长(约5.4 mm)的正方形ROI,测量每种纤维在X、Y和Z轴方向的扩散率(DX、DY、DZ),计算并比较2组患者的DTI-APLS指数值,并将其与年龄、受教育年限、慢性失眠年限、焦虑和抑郁量表(贝克抑郁自评量表、状态焦虑量表、状态特质焦虑量表)评分及匹兹堡睡眠质量指数进行Pearson相关性分析。使用ROC曲线评估扩散相关指标(DX、DY、DZ及ALPS指数等)对慢性失眠的诊断价值。结果:慢性失眠组的ALPS指数值显著低于对照组(t=-3.768,P<0.001)。DTI-ALPS指数与失眠年限呈显著负相关(r=-0.449,P=0.041),与年龄(r=-0.218,P=0.342)、受教育年限(r=0.015,P=0.950)、贝克抑郁自评量表评分(r=-0.139,P=0.549)、状态焦虑量表评分(r=-0.040,P=0.864)、状态特质焦虑量表评分(r=-0.095,P=0.682)及匹兹堡睡眠质量指数(r=-0.227,P=0.323)均无显著相关性。DTI-ALPS指数对区分慢性失眠与健康人群具有较好的诊断效能,AUC为0.811,敏感度为0.810,特异度为0.719。DX、DY、DZ值对区分慢性失眠与健康人群的敏感度和特异度均较低。结论:慢性失眠患者存在脑类淋巴系统功能障碍,且其程度与失眠的病程具有相关性。表征类淋巴循环功能的DTI-ALPS指数对区分慢性失眠患者与健康人群具有较高的诊断效能。
Objective:The purpose of this study was to explore the changes of cerebral glymphatic function in patients with chronic insomnia and to analyze its correlation with sleep state(insomnia duration and sleep quality)based on the analysis of perivascular space diffusion tensor imaging(DTI-APLS)index.Methods:The routine diffusion tensor imaging data of 21 patients with chronic insomnia and 32 healthy subjects were retrospectively analyzed.In the left cerebral hemisphere,two vo-xel side lengths(about 5.4mm)were drawn in the projective fiber area,the associated fiber area at the level of the lateral ventricle body,and the diffusivity(D)of each fiber in the X,Y and Z axes were measured.The DTI-APLS index values of the two groups were calculated and compared according to the formula.Pearson correlation analysis was conducted to evaluate the correlation of ALPS index with age,years of education,years of chronic insomnia and clinical scores of anxiety and depression scale(beck depression inventory,state anxiety inventory,and state-trait anxiety inventory)and Pittsburgh sleep quality index.ROC curve was used to evaluate the values of D X,D Y and D Z of projection fiber and contact fiber and ALPS index in the diagnosis of chronic insomnia.Results:ALPS index in patients with chronic insomnia was significantly lower than that in healthy controls(t=-3.768,P<0.001).DTI-ALPS index was negatively correlated with the number of years of insomnia in patients with chronic insomnia(r=-0.449,P=0.041).No significant correlation was found between DTI-ALPS index and age(r=-0.218,P=0.342),years of education(r=0.015,P=0.950),beck self-rating depression scale score(r=-0.139,P=0.549),state anxiety scale score(r=-0.040,P=0.864),state-trait anxiety scale score(r=-0.095,P=0.682)and Pittsburgh sleep quality index(r=-0.227,P=0.323).The DTI-ALPS index showed a better diagnostic performance in distinguishing chronic insomnia from healthy people,with maximum area under the curve(AUC)of 0.811,sensitivity of 0.810,and specificity of 0.719.The sensitivity and specificity of D X,D Y and D Z values to distinguish chronic insomnia from healthy people were low.Conclusion:The central glymphatic system dysfunction exists in patients with chronic insomnia,and the decline of cerebral lympha-tic function is related to the duration of insomnia.The DTI-ALPS index,which represents the function of the glymphatic circulation,has a high diagnostic efficacy in distinguishing patients with chronic insomnia from healthy people.
作者
郑秀梅
张治
梁晓
黄素华
吴麟
周福庆
ZHENG Xiu-mei;ZHANG Zhi;LIANG Xiao(Department of Imaging,the First Affiliated Hospital of Nanchang University,Jiangxi Institute of Medical Imaging,Nanchang 330006,China)
出处
《放射学实践》
CSCD
北大核心
2023年第12期1508-1512,共5页
Radiologic Practice
基金
江西省卫生健康委科技计划项目(202310273)
江西省高等学校教育改革研究项目(JXJG-21-1-33)
江西省自然科学基金资助项目(20232BAB216099)。
关键词
慢性失眠
类淋巴系统
血管周围间隙
扩散张量成像
Chronic insomnia
Lymphatic system
Perivascular space
Diffusion tensor imaging
