摘要
目的 应用氢质子MRI波谱成像(1H-MRS)技术探讨轻、中度甲状腺相关性眼病(TAO)视放射(OR)代谢物浓度的改变,探究甲状腺异常性视神经病(DON)的发病机理.方法 本研究为前瞻性,研究对象为2020年11月—2021年7月来我院就诊的眼科门诊(22例)及内分泌科住院(12例)的轻、中度TAO患者34例及同期向社会招募的15例健康志愿者[健康对照组(HC组)].根据纳入和排除标准,纳入TAO患者33例.根据临床活动评分(CAS)将TAO患者分为非活动性组14例、活动性组19例,根据病程分为慢性组(病程>6个月)17例、急性组(病程≤6个月)16例.研究采用用3.0 T MR设备、单体素1H-MRS技术,对研究者行轴面T1-反转恢复序列、水抑制点分辨频谱脉冲序列扫描;同时测量TAO患者的双侧突眼度,检测血清游离甲状腺激素(FT3、FT4)、促甲状腺激素(TSH)、抗甲状腺激素受体抗体(TRAb)、抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TgAb).采用单因素方差分析对TAO非活动性组、活动性组及HC组之间及TAO慢性组、急性组及HC组之间年龄及1H-MRS检测的代谢物[谷氨酰胺(Gln)、谷氨酸(Glu)、肌醇(mI)等]进行比较.采用x2检验比较TAO组和HC组的性别差异.使用Spearman相关分析对TAO患者突眼程度、血清检测指标与1H-MRS检测的代谢物浓度之间的相关性进行分析.结果 与HC组和活动性组相比,非活动性组患者OR中mI水平显著减低(F=3.29,P<0.05).与HC组相比,慢性组患者OR中Gln水平升高(F=3.31,P<0.05).在TAO各组中(非活动性组、活动性组,慢性组、急性组)突眼度均与TSH水平呈正相关,(r值分别为0.373,0.411,0.347,0.489;P均<0.05).结论 单体素1H-MRS能有效评估TAO患者OR微代谢的改变.
Abstract
Objective To investigate changes in metabolite concentrations in the optic radiation (OR) of patients with mild to moderate thyroid-associated ophthalmopathy (TAO) using proton magnetic resonance spectroscopy (1H-MRS) technology,and to explore the pathogenesis of dysthyroid optic neuropathy (DON). Methods This prospective study included 34 patients with mild and moderate TAO who visited the ophthalmology outpatient department(22 cases) or were hospitalized in the endocrinology department(12 cases)of our hospital between November 2020 and July 2021. An additional 15 healthy volunteers were recruited as the healthy control group (HC group). According to inclusion and exclusion criteria,33 TAO patients were included in the study. Based on the clinical activity score (CAS),TAO patients were divided into the inactive group (14 cases) and the active group (19 cases). According to the duration of the disease,they were further divided into the chronic group (disease duration>6 months,17 cases) and the acute group (disease duration ≤ 6 months,16 cases). The study employed a 3.0 T MR device and single-voxel 1H-MRS technology. Axial T1 inversion recovery sequences and water-suppressed point-resolved spectroscopy pulse sequences were performed. Simultaneously,proptosis measurements were taken,and serum levels of free thyroid hormones (FT3,FT4),thyroid-stimulating hormone (TSH),thyroid receptor antibodies (TRAb),thyroid peroxidase antibodies (TPOAb)],and thyroglobulin antibodies (TgAb) were collected. One-way Analysis of Variance was used to compare age and 1H-MRS detected metabolites[Glutamine (Gln),Glutamate (Glu),myo-Inositol(mI),etc.]among the TAO inactive group,active group,and HC group,as well as among the TAO chronic group,acute group,and HC group. The x2 test was used to compare gender differences between the TAO and the HC group. Spearman correlation analysis was used to assess the correlation between the degree of proptosis,serum indicators,and the concentrations of metabolites detected by 1H-MRS in TAO patients. Results Compared with the HC group and the active group,the mI levels in the OR of the inactive group were significantly decreased (F=3.29,P<0.05). Compared with the HC group,the Gln levels in the OR of the chronic group were increased (F=3.31,P<0.05). The degree of proptosis in all TAO groups (inactive group,active group,chronic group,acute group) was positively correlated with TSH levels,with r values of 0.373,0.411,0.347 and 0.489 respectively (all P<0.05). Conclusion Single-voxel 1H-MRS can effectively assess metabolite changes in the OR of patients with TAO.
维普
万方数据