【作者】 王宁；

【导师】 刘强； 姚建；

【作者基本信息】 泰山医学院 ， 影像医学与核医学， 2011， 硕士

【摘要】 目的利用磁共振氢质子波谱(Proton Magnetic Resonance Spectroscopy,1H-MRS)技术,从分子影像学水平对Ⅱ型糖尿病患者下肢骨骼肌内的常见代谢物进行定量及半定量分析,研究Ⅱ型糖尿病患者骨骼肌的代谢改变,探讨糖尿病周围神经病变(DPN)与骨骼肌组织内代谢物变化的关联性,探讨磁共振氢质子波谱(1H-MRS)在糖尿病周围神经病变(DPN)诊断中的应用价值。材料与方法1、研究对象的选择联系山东省立医院内分泌科,2010年3月至2010年10月间选取48例经完整资料诊断为Ⅱ型糖尿病的患者,其中男性24例,女性24例,平均年龄54.5±10.5岁,年龄范围40～84岁,病程7天～25年。所有患者均行小腿部位肌电图检查。根据肌电图结果是否存在周围神经损伤作为糖尿病周围神经病变(DPN)的诊断标准,将T2DM病例分成两组:有周围神经病变组(A组)23例(男性10例,女性13例,平均年龄56.7±8.7岁,年龄范围46-84岁)和无周围神经病变组(B组)25例(男性14例,女性11例,平均年龄54.7±9.3岁,年龄范围40-70岁)。所有受试对象均排除其他原因所致的周围神经病变。同时在健康查体者中随机选择年龄、性别相匹配的健康成年人作为对照组(C组)共24例,(男性11例,女性13例,平均年龄52.2±13.1岁,年龄范围30-77岁)。组间年龄(F=1.092,P=0.341)、性别(F=0.361,P=0.550)均无显著性差异。2、设备与方法采用德国西门子公司1.5T超导型全身MRI扫描仪(Magnetom Sonata Maestro Class)和标准膝关节线圈。扫描序列包括小腿部位常规序列和1H-MRS序列。检查时均取仰卧位,足先进。小腿比目鱼肌中心与线圈中心线重合。所有受试对象在检查前签署知情同意书。常规扫描序列具体参数如下:横断位以及冠状位T1WI(TR 450ms,TE 13ms)、冠状FS-T2WI(TR 3540ms,TE 85ms)以及矢状位Pd+T2WI(TR 3000ms,TE 14ms)。FOV 200mm×200mm,层厚10mm,层间距5mm。常规序列扫描完成后,以横断位、冠状位、矢状位三方位T1WI图像作为1H-MRS的定位像,进行磁共振波谱成像序列(1H-MRS)扫描。1H-MRS具体参数如下:单体素(SVS),激励回波探测法(stimulated-echo acquisition mode,STEAM),FOV 180mm,TR 1500ms,TE 30ms,采集次数128次,采集时间180s,带宽1000Hz,体素大小20mm×20mm×20mm。1H-MRS扫描前自动采用化学位移饱和法(chemical shift selective saturation,CHESS)进行水抑制,水抑制频率为35Hz。感兴趣区(ROI)定位在小腿比目鱼肌内,同时避开邻近血管、肌筋膜及周围脂肪等成分对数据采集的影响,以确保数据准确性。扫描完成后,将1H-MRS原始数据调至工作站波谱选项卡中经后处理软件进行交互式处理得到包含所有待分析物质的谱线图以及各物质的峰值下面积积分值,主要有:肌酸(Cr)、胆碱复合物(Cho)、细胞外脂肪(EMCL)、细胞内脂肪(IMCL),并以Cr为内标准取得Cho/Cr、EMCL/Cr、IMCL/Cr的相对含量值。可以对谱线图进行手动后处理,使物质含量值更加精确。3、统计分析采用SPSS17.0统计分析软件包,所有计量资料均采用?χ±s表示。数据正态性检验和方差齐性检验分别采用单样本Kolmogorov-Smirnov检验和Levene检验。应用单因素方差分析(one-way ANOVA)对组间常见代谢物的含量及相对含量进行比较分析。P<0.05为有差异,P<0.01为有显著差异。结果各组间的Cho、Cr、EMCL、IMCL峰下的面积及Cho/Cr、EMCL/Cr、IMCL/Cr比值比较结果如下:1、糖尿病周围神经病变组(A组)与糖尿病无周围神经病变组(B组)比较:Cr、Cho、EMCL、IMCL、Cho/Cr含量的差异没有统计学意义(P>0.05);EMCL/Cr、IMCL/Cr含量的差异有统计学意义(P<0.05);2、糖尿病周围神经病变组(A组)与对照组(C组)比较:Cr、Cho、EMCL、EMCL/Cr含量的差异没有统计学意义(P>0.05);IMCL、Cho/Cr、IMCL/Cr含量的差异有统计学意义(P<0.05);3、糖尿病无周围神经病变组(B组)与对照组(C组)比较:Cr、Cho、EMCL、Cho/Cr含量的差异没有统计学意义(P>0.05);IMCL、EMCL/Cr、IMCL/Cr含量的差异有统计学意义(P<0.05)。结论与正常人相比,糖尿病患者比目鱼肌内IMCL、IMCL/Cr升高,其中糖尿病无周围神经病变患者比目鱼肌中IMCL、EMCL/Cr、IMCL/Cr升高,糖尿病周围神经病变患者比目鱼肌中IMCL、Cho/Cr、IMCL/Cr升高。因此,利用1H-MRS对小腿骨骼肌组织内的常见代谢物进行定量分析,评价骨骼肌组织的代谢改变对Ⅱ型糖尿病周围神经病变的诊断具有一定的参考价值。更多还原

【Abstract】 ObjectiveTo investigate quantitatively common metabolites contents in lower limb skeletal muscle of patients with typeⅡdiabetes with diabetic peripheral neuropathy (DPN), typeⅡdiabetes without diabetic peripheral neuropathy (DPN) and healthy people from the level of molecular imaging using proton magnetic resonance spectroscopy techniques (1H-MRS). At the same time, discuss some changes of common metabolite contents in skeletal muscles among three groups, and to evaluate the value of magnetic resonance proton spectroscopy (1H-MRS) in diabetic peripheral neuropathy (DPN) diagnosis. Materials and Methods1. The choice of subjectsCooperation with the Department of Endocrinology, Shandong Provincial Hospital, 48 patients with typeⅡdiabetes diagnosed by the complete data (24 males, 24 females, mean age 54.5±10.5 years, range 40-84years old, course 7d-25 years) were selected in the study from March 2010 to October 2010. All patients were checked EMG examination in the calf, and were grouped into a peripheral neuropathy group (A group) 23 patients (10 males and 13 females, mean age 56.7±8.7 years, range 46-84 years) and without peripheral neuropathy group (B group), 25 cases (14 males and 11 female, mean age 54.7±9.3 years, range 40-70 years) according to EMG showed nerve damage as a diabetic peripheral neuropathy (DPN) in the diagnostic criteria.At the same time, 24 healthy adults (11 males, 13 females, mean age 52.2±13.1 years, range 20-25 years old) without T2DM were randomly selected as a control group from people who are health check. All subjects were excluded peripheral nerve lesions due to other causes. Age (F=1.092, P=0.341), gender (F=0.361, P=.550) among the three groups were not significantly different. 1.5T superconducting magnetic resonance scanner (Germany Siemens Magnetom Sonota Maestro Class) and standard knee coil was used. Scanning Sequences include the conventional sequence and MRS sequences.All subjects carried out axial and coronary T1-weighted imaging(TR 450ms, TE 13ms), coronary T2-weighted imaging(TR 3540ms, TE 85ms) and sagittal Proton density-weighted image (TR 3000ms, TE 14ms). FOV is 240mm×240mm, thickness is 10mm, with 5mm spacing.When the conventional serial scan is complete, transverse, sagittal and coronal T1-weighted image was used for positioning magnetic resonance spectroscopy. Specific parameters are as follows: single-voxel (SVS), stimulated-echo acquisition mode (STEAM),FOV 180mm,TR 1500 ms,TE 30ms,acquisition 128 times, scan time 180s, bandwidth of 1000Hz, voxel 20mm×20mm×20mm. ROI (ROI) placed on the soleus muscle in the calf, avoiding the adjacent blood vessels, fascia and the surrounding fat in order to remove their impact on data collection to ensure that collected data is more accurate. Before MRS scanning, water suppression were automatically performed by chemical shift saturation method (chemical shift selective saturation, CHESS), and the frequency of the water suppression is 35Hz.After scanning, the original spectral data was transferred to the spectrum tab of workstations, which were processed by the interactive processing software automatically. Finally, MRS curves containing all the substances to be analyzed and the peak integral areas under these materials were obtained, the most of them including creatine (Cr), choline (Cho), extra-myocellular liplids (EMCL), intra-myocellular liplids (IMCL) and relative content of Cho/Cr, EMCL/Cr, IMCL/Cr. Subsequently, if dissatisfactory, manual adjustment could be made on the MRS curves, in order to obtain more precise values of material content.3. Statistical AnalysisSPSS 17.0 statistical analysis software package was used. All measurement data are indicated with?χ±s. Single-sample Kolmogorov-Smirnov test and Levene test were used to test data normality and homogeneity of variance. One-way analysis of variance (ANOVA) was used to analyze the content and relative content differences of a material among there groups. To make the P<0.05 as a difference and P <0.01 as the significant difference.ResultsComparison results of areas under the peak Cho, Cr, EMCL, IMCL and the ratio of Cho/Cr, EMC /Cr, IMCL/Cr among there groups are as follows:2. Equiment and Methods 1. Between diabetic peripheral neuropathy group (A group) and diabetic patients without peripheral neuropathy group (B group): Content differences of Cr, Cho, EMCL, IMCL and Cho/Cr was not statistically significant (P> 0.05); Content differences of EMCL/Cr and IMCL/Cr was statistically significant (P<0.05);2. Between diabetic peripheral neuropathy group (A group) and control group (C group): Content differences of Cr, Cho, EMCL and EMCL/Cr was not statistically significant (P> 0.05); Content differences of IMCL, Cho/Cr and IMCL/Cr was statistically significant (P<0.05);3. Between diabetic patients without peripheral neuropathy group (B group) and control group (C group): Content differences of Cr, Cho, EMCL and Cho/Cr was not statistically significant (P> 0.05); Content differences of IMCL, EMCL/Cr and IMCL/Cr was statistically significant (P<0.05). ConclusionCompared with healthy people, IMCL, IMCL/Cr in soleus muscle increase in T2DM patients. IMCL, EMCL/Cr, IMCL/Cr increase in T2DM patients without peripheral neuro- pathy; IMCL, Cho/Cr, IMCL/Cr increase in T2DM patients with peripheral neuropat- hy. Therefore, 1H-MRS has some reference value in the diagnosis of peripheral neuropathy in T2DM patients by testing contents and relative contents of some common metabolites and by analyzing certain metabolic changes of the calf muscle tissue.更多还原