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贫血为外周血单位容积内血红蛋白浓度、红细胞总数低于相同年龄、性别及地域人群的参考范围下限时出现的一种症状[1]。贫血在临床中比较常见,除了血液系统疾病本身会引起贫血外,大部分是由其他系统疾病引起[2]。贫血患者早期症状不明显,但随着时间推移及贫血程度加重会逐渐出现全身各系统的临床症状,其中对于神经系统的影响主要导致患者头痛、眩晕、失眠、多梦、记忆力减退和注意力不集中等。PET脑代谢显像能灵敏地发现情感与认知功能脑区的代谢异常,以往的研究结果显示,糖尿病[3]及肿瘤[4]患者PET脑代谢显像均出现情感等功能脑区葡萄糖代谢异常,但对于贫血患者脑葡萄糖代谢改变的研究目前罕有报道。本研究回顾性分析了51例贫血患者的脑部PET/CT影像资料,以期探讨贫血患者脑葡萄糖代谢改变的特点及其临床意义。
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贫血患者与健康对照者的年龄分布差异无统计学意义(t=−0.448,P=0.655)。51例贫血患者中,女性占比明显高于男性(68.6%对31.4%),且差异有统计学意义(χ2=4.564,P=0.026)。贫血患者的一般资料和血红蛋白浓度见表1,其中轻度、中度、重度贫血患者分别为27、18、6例。
贫血程度 性别 例数 年龄(岁) 血红蛋白浓度(g/L) 轻度贫血 男 9 30~55(39.67±8.41) 94~118(108.25±10.57) 女 18 21~60(38.33±14.99) 92~107(99.26±4.72) 中度贫血 男 5 31~54(46.80±9.31) 68~86(80.80±7.29) 女 13 22~55(41.62±10.22) 70~85(77.85±5.93) 重度贫血 男 2 47~52(49.50±3.54) 43~52(47.50±6.36) 女 4 22~50(37.25±13.89) 42~56(50.50±6.45) 表 1 贫血患者的一般资料和血红蛋白浓度
Table 1. General data and hemoglobin concentration in anemia patients
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与健康对照者比较,贫血患者在静息状态下脑18F-FDG PET图像均以葡萄糖代谢减低为主,涉及的脑区包括双侧额上、中、下回,右侧颞叶下回和右侧顶下小叶,未见明显代谢增高脑区,总体素数为3705个,其代谢减低区的具体分布见图1和表2。
图 1 51例贫血患者与56名健康对照者比较脑葡萄糖代谢减低区的统计参数图 蓝色所示代谢减低区为双侧额上、中、下回,右侧颞叶下回和右侧顶下小叶
Figure 1. The statistical parameter map of cerebral glucose metabolism decreased in 51 patients with anemia compared with 56 normal controls
脑功能区 Talairach坐标 体素数(个) t值 P值 X Y Z 左侧额上回 −24 64 −8 88 5.56 <0.05 左侧额中下回 −32 8 48 591 5.74 <0.05 右侧额上回 26 32 48 115 5.53 <0.05 右侧额中回 36 −10 50 1299 5.01 <0.05 右侧额下回 52 10 4 375 5.69 <0.05 右侧颞叶下回 68 −64 −6 736 5.85 <0.05 右侧顶下小叶 40 −42 42 501 5.62 <0.05 表 2 51例贫血患者与56名健康对照者比较脑葡萄糖代谢 的减低区
Table 2. Positions of the reduced glucose metabolism cerebral regions in 51 patients with anemia compared with 56 normal controls
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与轻度贫血患者比较,中度贫血患者脑葡萄糖代谢减低区见于双侧额下回、右侧额中回、右侧颞叶下回和右侧顶下小叶,总体素数为832个,其代谢减低区的具体分布见图2和表3。与轻度贫血患者比较,重度贫血患者脑葡糖糖代谢减低区见于双侧额上回、双侧额中下回、右侧颞叶下回和右侧顶下小叶,总体素数为1834个,其代谢减低区的具体分布见图3和表4。与中度贫血患者比较,重度贫血患者脑葡萄糖代谢减低区见于左侧额上回、左侧额中下回、右侧额中回、右侧颞叶下回和右侧顶下小叶,总体素数为1598个,其代谢减低区的具体分布见图4和表5。
图 2 18例中度贫血患者与27例轻度贫血患者比较脑葡萄糖代谢减低区的统计参数图
Figure 2. The statistical parameter map of cerebral glucose metabolism decreased in 18 patients with moderate anemia compared with 27 mild anemia
脑功能区 Talairach坐标 体素数(个) t值 P值 X Y Z 左侧额下回 −60 34 0 195 5.58 <0.05 右侧额下回 58 52 2 207 5.86 <0.05 右侧额中回 24 −14 58 241 5.84 <0.05 右侧颞叶下回 52 12 −10 65 5.22 <0.05 右侧顶下小叶 24 −38 40 124 5.31 <0.05 表 3 18例中度贫血患者与27例轻度贫血患者比较脑葡萄 糖代谢的减低区
Table 3. Positions of the reduced glucose metabolism cerebral regions in 18 patients with moderate anemia compared with 27 mild anemia
图 3 6例重度贫血患者与27例轻度贫血患者比较脑葡萄糖代谢减低区的统计参数图
Figure 3. The statistical parameter map of cerebral glucose metabolism decreased in 6 patients with severe anemia compared with 27 mild anemia
脑功能区 Talairach坐标 体素数(个) t值 P值 X Y Z 左侧额上回 −8 52 58 300 6.05 <0.05 左侧额中下回 −38 36 54 242 5.80 <0.05 右侧额上回 10 −14 82 126 5.54 <0.05 右侧额中下回 50 2 44 469 5.42 <0.05 右侧颞叶下回 46 −8 −50 351 5.80 <0.05 右侧顶下小叶 34 −46 62 346 5.73 <0.05 表 4 6例重度贫血患者与27例轻度贫血患者比较脑葡萄糖 代谢的减低区
Table 4. Positions of the reduced glucose metabolism cerebral regions in 6 patients with severe anemia compared with 27 mild anemia
图 4 6例重度贫血患者与18例中度贫血患者比较脑葡萄糖代谢减低区的统计参数图
Figure 4. The statistical parameter map of cerebral glucose metabolism decreased in 6 patients with severe anemia compared with 18 moderate anemia
脑功能区 Talairach坐标 体素数 t值 P值 X Y Z 左侧额上回 −26 −14 70 295 5.95 <0.05 左侧额中下回 −36 64 8 174 6.44 <0.05 右侧额中回 48 34 42 662 5.72 <0.05 右侧颞叶下回 74 −30 −28 325 5.92 <0.05 右侧顶下小叶 36 −44 62 142 6.48 <0.05 表 5 6例重度贫血患者与18例中度贫血患者比较脑葡萄糖 代谢的减低区
Table 5. Positions of the reduced glucose metabolism cerebral regions in 6 patients with severe anemia compared with 18 moderate anemia
贫血患者大脑静息葡萄糖代谢改变的研究
Changes in resting-state brain glucose metabolism in patients with anemia
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摘要:
目的 探讨不同程度贫血患者大脑静息状态下葡萄糖代谢改变的特点。 方法 回顾性分析2016年12月至2019年4月经郑州大学人民医院临床诊断为贫血的51例患者的脑部18F-氟脱氧葡萄糖(FDG)PET/CT影像资料,其中男性16例、女性35例,年龄21~60(41.13±9.78)岁。根据WHO和相关文献中的贫血诊断标准将患者分为轻度贫血(90 g/L~正常下限)、中度贫血(60~90 g/L)、重度贫血(30~60 g/L)3组。将56名同期行全身PET/CT检查的健康体检者作为对照组,其中男性29名、女性27名,年龄19~58(41.96±9.27)岁。采用统计参数图(SPM)8软件对贫血患者及健康对照者的PET图像进行处理与分析。分别将贫血患者与健康对照者,轻度、中度、重度贫血患者间的脑PET图像进行体素对体素的两独立样本t检验,得到各自组间的脑葡萄糖代谢差异分布图,同时利用xjView软件对差异有统计学意义的脑区进行立体定位分析及体素值定量分析,得出各异常区域的t值。 结果 与健康对照者比较,贫血患者脑PET图像表现为区域性大脑静息葡萄糖代谢减低,累及的脑区包括双侧额上、中、下回,右侧颞叶下回和右侧顶下小叶,未见明显代谢增高脑区,总体素数为3705个(t=5.01~5.85,均P<0.05)。与轻度贫血患者比较,中度贫血患者脑代谢减低区见于双侧额下回、右侧额中回、右侧颞叶下回和右侧顶下小叶,总体素数为832个(t=5.22~5.86,均P<0.05);重度贫血患者脑代谢减低区见于双侧额上回、双侧额中下回、右侧颞叶下回和右侧顶下小叶,总体素数为1834个(t=5.42~6.05, 均P<0.05)。与中度贫血患者比较,重度贫血患者脑代谢减低区见于左侧额上回、左侧额中下回、右侧额中回、右侧颞叶下回和右侧顶下小叶,总体素数为1598个(t=5.72~6.48,均P<0.05)。 结论 贫血患者大脑静息状态下葡萄糖代谢改变以区域性葡萄糖代谢减低为主,代谢减低区多涉及情感、认知等相关的脑区,且随着贫血程度的加重,脑代谢减低区的范围扩大。 -
关键词:
- 贫血 /
- 氟脱氧葡萄糖F18 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 大脑 /
- 葡萄糖代谢
Abstract:Objective To investigate changes in resting glucose metabolism in the brain of patients with anemia of different degrees. Methods The brain 18F-fluorodeoxyglucose (FDG) PET/CT imaging data of 51 patients who were clinically diagnosed with anemia in People's Hospital of Zhengzhou University from December 2016 to April 2019 were retrospectively analyzed. The study population included 16 males and 35 females aged 21−60 (41.13±9.78) years. According to the diagnostic criteria of anemia in WHO and relevant literature, the patients were divided into 3 groups: mild anemia (90 g/L–lower limits of normal), moderate anemia (60–90 g/L) and severe anemia (30−60 g/L). A total of 56 healthy physical examiners were recruited as controls; this group included 29 males and 27 females aged 19–58 (41.96±9.27) years. Statistical Parametric Mapping 8 software was used to process and analyze the PET images of anemia group and healthy controls. The brain PET images of all anemia groups and the control group were tested by voxel-to-voxel two-sample t-test to obtain difference distribution maps of brain PET metabolism between each group. XjView software was used to conduct stereotaxic and quantitative analyses of voxel values in brain regions reflecting statistical differences. The t values of all abnormal regions were obtained. Results Compared with those in the control group, hypometabolic brain areas in patients with anemia were mainly distributed in the bilateral superior, middle, and inferior frontal gyri; the right inferior temporal gyri; and the right inferior parietal lobule gyri, the total voxel value was 3705 (t=5.01–5.85, all P<0.05). Hypermetabolic areas were not observed in anemia patients. Compared with that in the mild group, hypometabolism in the moderate group was observed in the bilateral inferior frontal, right middle frontal, right inferior temporal gyri, and the right inferior parietal lobule gyri, the total voxel value was 832 (t=5.22–5.86, all P<0.05). Hypometabolism in the severe group was observed in the bilateral superior frontal, bilateral middle-inferior frontal, right inferior temporal, and right inferior parietal lobule gyri, the total voxel value was 1834 (t=5.42–6.05, all P<0.05). Compared with that in the moderate group, hypometabolism in the severe group was noted in the left superior frontal, left middle-inferior frontal, and right middle frontal gyri, right inferior temporal lobe, and right inferior parietal lobule gyri, the total voxel value was 1598 (t=5.72–6.48, all P<0.05). Conclusions Patients with anemia showed relative reductions in regional cerebral resting glucose metabolism. The cerebral regions demonstrating reduced metabolism were mainly related to emotion cognition. As anemia progressed, areas reflecting a decrease in cerebral metabolism increased. -
表 1 贫血患者的一般资料和血红蛋白浓度
Table 1. General data and hemoglobin concentration in anemia patients
贫血程度 性别 例数 年龄(岁) 血红蛋白浓度(g/L) 轻度贫血 男 9 30~55(39.67±8.41) 94~118(108.25±10.57) 女 18 21~60(38.33±14.99) 92~107(99.26±4.72) 中度贫血 男 5 31~54(46.80±9.31) 68~86(80.80±7.29) 女 13 22~55(41.62±10.22) 70~85(77.85±5.93) 重度贫血 男 2 47~52(49.50±3.54) 43~52(47.50±6.36) 女 4 22~50(37.25±13.89) 42~56(50.50±6.45) 表 2 51例贫血患者与56名健康对照者比较脑葡萄糖代谢 的减低区
Table 2. Positions of the reduced glucose metabolism cerebral regions in 51 patients with anemia compared with 56 normal controls
脑功能区 Talairach坐标 体素数(个) t值 P值 X Y Z 左侧额上回 −24 64 −8 88 5.56 <0.05 左侧额中下回 −32 8 48 591 5.74 <0.05 右侧额上回 26 32 48 115 5.53 <0.05 右侧额中回 36 −10 50 1299 5.01 <0.05 右侧额下回 52 10 4 375 5.69 <0.05 右侧颞叶下回 68 −64 −6 736 5.85 <0.05 右侧顶下小叶 40 −42 42 501 5.62 <0.05 表 3 18例中度贫血患者与27例轻度贫血患者比较脑葡萄 糖代谢的减低区
Table 3. Positions of the reduced glucose metabolism cerebral regions in 18 patients with moderate anemia compared with 27 mild anemia
脑功能区 Talairach坐标 体素数(个) t值 P值 X Y Z 左侧额下回 −60 34 0 195 5.58 <0.05 右侧额下回 58 52 2 207 5.86 <0.05 右侧额中回 24 −14 58 241 5.84 <0.05 右侧颞叶下回 52 12 −10 65 5.22 <0.05 右侧顶下小叶 24 −38 40 124 5.31 <0.05 表 4 6例重度贫血患者与27例轻度贫血患者比较脑葡萄糖 代谢的减低区
Table 4. Positions of the reduced glucose metabolism cerebral regions in 6 patients with severe anemia compared with 27 mild anemia
脑功能区 Talairach坐标 体素数(个) t值 P值 X Y Z 左侧额上回 −8 52 58 300 6.05 <0.05 左侧额中下回 −38 36 54 242 5.80 <0.05 右侧额上回 10 −14 82 126 5.54 <0.05 右侧额中下回 50 2 44 469 5.42 <0.05 右侧颞叶下回 46 −8 −50 351 5.80 <0.05 右侧顶下小叶 34 −46 62 346 5.73 <0.05 表 5 6例重度贫血患者与18例中度贫血患者比较脑葡萄糖 代谢的减低区
Table 5. Positions of the reduced glucose metabolism cerebral regions in 6 patients with severe anemia compared with 18 moderate anemia
脑功能区 Talairach坐标 体素数 t值 P值 X Y Z 左侧额上回 −26 −14 70 295 5.95 <0.05 左侧额中下回 −36 64 8 174 6.44 <0.05 右侧额中回 48 34 42 662 5.72 <0.05 右侧颞叶下回 74 −30 −28 325 5.92 <0.05 右侧顶下小叶 36 −44 62 142 6.48 <0.05 -
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