载脂蛋白Eε4基因对轻度认知功能障碍患者脑白质微细结构损害研究

doi:10.3969/j.issn.1007-9572.2016.26.010

摘要/Abstract

摘要： 背景　目前国内外对磁共振弥散张量成像（DTI）和轻度认知功能障碍（MCI）的相关性研究较多，但针对DTI临床评价MCI载脂蛋白Eε4（ApoEε4）基因携带者脑白质变化的研究还比较少见。目的　利用功能影像学优势，研究ApoEε4基因对MCI患者脑白质微细结构损害，为临床早期治疗MCI患者提供理论依据。方法　选取2012—2013年新疆医科大学第二附属医院、新疆医科大学附属中医院就诊的维吾尔族、汉族MCI患者26例，根据ApoE等位基因亚型测试结果，其中13例为ApoEε4基因携带者（A组），13例为非ApoEε4基因携带者（B组）；另选取同期两院体检健康者15例为C组。对受试者进行DTI扫描，记录双侧颞叶、双侧海马、双侧顶叶、双侧枕叶、胼胝体压部、扣带回后部白质区域表观扩散系数（ADC）和部分各向异性（FA）值。结果　3组双侧颞叶、双侧顶叶、双侧枕叶、扣带回后部ADC、FA值比较，差异均无统计学意义（P>0.05）；3组双侧海马、胼胝体压部ADC、FA值比较，差异均有统计学意义（P<0.05）；其中B组和C组双侧海马、胼胝体压部ADC值低于A组，C组双侧海马、胼胝体压部ADC值低于B组；B组双侧海马FA值高于A组，C组双侧海马、胼胝体压部FA值均高于A组和B组（P<0.05）。MCI ApoEε4基因携带者蒙特利尔认知评估量表（MoCA）评分为（20.1±3.2）分。相关性分析结果显示，MCI ApoEε4基因携带者双侧海马、胼胝体压部ADC值与MoCA评分呈正相关（P<0.05）。结论　从脑白质微细结构损害的角度来说，MCI患者主要出现在双侧海马、胼胝体压部，且ApoEε4基因携带者较非携带者脑白质微细结构损害的程度变化更明显，且与MoCA评分存在相关性。

关键词: 轻度认知障碍, 弥散张量成像, 载脂蛋白E4, 海马, 胼胝体

Abstract: Background　At present，there are many researches about the correlation between the magnetic resonance diffusion tensor imaging（DTI）and mild cognitive impairment（MCI）both at home and abroad，but studies on the changes of cerebral white matter by clinical evaluation of DTI on MCI ApoEε4 gene carriers are still relatively rare.Objective　To study the damage of ApoEε4 gene on cerebral white matter microstructure of MCI patients by taking advantages of functional imaging and to provide a theoretical basis for early clinical treatment of MCI patients.Methods　26 Uyghur and Han patients with MCI，who received treatment in the Second Affiliated Hospital of Xinjiang Medical University and Affiliated Chinese Medicine Hospital of Xinjiang Medical University from 2012 to 2013，were selected.According to the test results of ApoE allele subtypes，13 were ApoEε4 gene carriers（A group），13 cases of non-ApoEε4 gene carriers（B group）；and another 15 who were healthy after physical examination at the same period in these two hospitals were enrolled as C group.DTI scanning of the subjects were performed to record the apparent diffusion coefficient（ADC）and fractional anisotropy（FA）values of the bilateral,temporal lobe,hippocampus，parietal lobe，occipital lobe，splenium of corpus callosum，and posterior cingulate gyrus.Results　There were no significant differences among the three groups in ADC and FA values of bilateral temporal lobe，parietal lobe，occipital lobe，and posterior cingulated gyrus（P>0.05）；the comparison of ADC and FA values of bilateral hippocampus and splenium of corpus callosum among the three groups were significantly different（P<0.05）；the ADC values of bilateral hippocampus and splenium of corpus callosum in B and C group were lower than those in A group，ADC value of bilateral hippocampus and splenium of corpus callosum in C group was lower than that in B group；FA value of bilateral hippocampus in B group was higher than that in A group，FA value of bilateral hippocampus and splenium of corpus callosum in C group was higher than that in A and B group（P<0.05）.MoCA score of MCI ApoEε4 gene carriers was（20.1±3.2）.Correlation analysis showed that ADC values of bilateral hippocampus and splenium of corpus callosum of MCI ApoEε4 gene carriers were positively correlated with MoCA score（P<0.05）.Conclusion　From the perspective of the damage of white matter microstructure，it mainly occurs in bilateral hippocampus and splenium of corpus callosum of MCI patients.Moreover，the changing extent of the damage in white matter microstructure of ApoEε4 gene carriers is more obvious than that of non-ApoEε4 gene carriers，and has correlation with MoCA score.

Key words: Mild cognitive impairment, Diffusion tensor imaging, Apolipoprotein E4, Hippocampus, Corpus callosum

李海涛, 李桂花, 哈斯也提·依不来音, 朱国峰, 马依日木·赛买提, 阿依吐拉·卡迪尔, 王丹, 杨新玲. 载脂蛋白Eε4基因对轻度认知功能障碍患者脑白质微细结构损害研究[J]. 中国全科医学, 2016, 19(26): 3175-3179.

LI Hai-tao, LI Gui-hua, HASIYETI·Yibulaiyin, ZHU Guo-feng, MAYIRIMU·Saimaiti, AYITULA·Kadier, WANG Dan, YANG Xin-ling. Damage of ApoEε4 Gene on Cerebral White Matter Microstructure of Patients with Mild Cognitive Impairment[J]. Chinese General Practice, 2016, 19(26): 3175-3179.

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