Page 111 - 南京医科大学学报自然科学版

第41卷第5期 南京医科大学学报（自然科学版）
2021年5月 Journal of Nanjing Medical University（Natural Sciences） ·741 ·

·影像医学·

定量磁敏感图对终末期肾病患者脑铁沉积的定量研究

于旻昊，张 妮，贾中正 ，周学军，陈 悦，葛 敏，胡 月
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南通大学附属医院医学影像科，江苏 南通 226001

［摘 要］ 目的：应用定量磁敏感图（quantitative susceptibility mapping，QSM）比较终末期肾病（end⁃stage renal disease，ESRD）
患者和健康对照者大脑深部灰质核团的磁敏感值（magnetic susceptibility value，MSV），并分析ESRD患者MSV与蒙特利尔认知
评估量表（montreal cognitive assessment，MoCA）评分的相关性，探讨QSM技术评估ESRD患者脑铁沉积的价值以及脑铁沉积对
认知功能的影响。方法：招募南通大学附属医院25例ESRD患者及25例年龄性别相匹配的健康对照者，应用QSM技术测量每
个人大脑深部灰质核团的 MSV，应用 Mann⁃Whitney U 检验比较各核团 MSV 的差异，应用受试者工作特征（receiver operating
characteristic，ROC）曲线分析评价其诊断效能，应用Spearman相关性分析评估ESRD患者MSV与MoCA评分的相关性。结果：
ESRD 患者双侧红核（red nucleus，RN）、黑质（substantia nigra，SN）、尾状核头部（caudate head，CA）、壳核（putamen，PU）的 MSV
大于健康对照者（P 均＜0.05）。双侧 RN、SN、PU 及 CA 的 MSV 可以区分 ESRD 患者与健康对照者，当右侧 PU 的 MSV 为 0.085
时，曲线下面积（area under the curve，AUC）最大，敏感性为67%，特异性为91%。ESRD患者右侧RN的MSV与语言能力、抽象
能力呈负相关，左侧CA的MSV与注意力、语言能力呈负相关，左侧苍白球（globus pallidus，GP）的MSV和视觉空间与执行能力
呈负相关（P均＜0.05）。结论：QSM技术不仅可以定量评估ESRD患者脑内铁沉积，还可以分析ESRD患者脑内铁沉积对认知功
能的影响。
［关键词］ 终末期肾病；脑；磁共振成像；铁；定量
［中图分类号］ R816.7 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）05⁃741⁃05
doi：10.7655/NYDXBNS20210519

Quantitative study of brain iron deposition in patients with end ⁃ stage renal disease by
quantitative susceptibility mapping

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YU Minhao，ZHANG Ni，JIA Zhongzheng ，ZHOU Xuejun，CHEN Yue，GE Min，HU Yue
Department of Medical Imaging，Affiliated Hospital of Nantong University，Nantong 226001，China

［Abstract］ Objective： This study aims to explore the effect of quantitative susceptibility mapping（QSM）in evaluating brain iron
deposition in the patients with end⁃stage renal disease（ESRD）and the impact of iron deposition on cognitive function by comparing the
magnetic susceptibility value（MSV）of the deep gray matter nuclei between the patients with ESRD and healthy controls，and analyzed
the correlations between the MSVs of the patients with ESRD and the scores of the Montreal Cognitive Assessment（MoCA）. Methods：
Twenty⁃five patients with ESRD and 25 healthy controls who are age and sex⁃matched were recruited in this study. The MSVs of the
deep gray matter nuclei of all the patients with ESRD and healthy controls were measured with QSM. The differences of the MSVs of
the nuclei between the patients and controls were analyzed by the Mann⁃Whitney U test. The diagnostic efficacy of the MSVs was
analyzed by the receiver operating characteristic（ROC）curve. The correlations between the MSVs of the patients and the scores of the
MoCA were analyzed by Spearman correlation analysis. Results：In the patients with ESRD，the MSVs of bilateral red nucleus（RN），
substantia nigra（SN），caudate head（CA）and putamen（PU）were higher than those in the controls（P＜0.05 respectively）. The MSVs
of bilateral RN，SN，PU and CA can distinguish the patients from healthy controls. ROC analysis revealed that the cut⁃off values of PU
MSV（0.085）provided the best combination of sensitivity（67%）and specificity（91%）to distinguish the ESRD patients from controls.
In the patients with ESRD，the MSV of the right RN was negatively correlated with language ability and abstract ability，the left CA was
negatively correlated with attention and language ability，and the left globus pallidus（GP）was negatively correlated with visuospatial

［基金项目］ 江苏省卫生健康委科研项目（H2019089）；南通市科技计划项目（MS12020044）
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通信作者（Corresponding author），E⁃mail：jzz2397@163.com