作者：崔丽萍，李淑娟，张红，刘伟安，刘艳，王晓东，朱佳荣，苑秀梅，王帆，魏艳萍

单位：

1.宁夏医科大学总医院全科医学科2.宁夏医科大学总医院心脑血管病医院急诊科3.宁夏医科大学总医院呼吸与危重症医学科4.宁夏医科大学总医院放射科

Units：

1.Department of General Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China 2.Department of Emergency, Hospital of Cardiovascular and Cerebrovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan 750004, China 3.Department of Respiratory and Critical Medicine, General Hospital of Ningxia Medical University, Yinchuan 750004, China 4.Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan 750004, China

关键词：

睡眠呼吸暂停,阻塞性; 缺血性脑卒中; 弥散张量成像; 白质;

Keywords：

Sleep apnea, obstructive; Ischemic stroke; Diffusion tensor imaging; White matter

CLC：

R 563.8 R 743.3

DOI：

10.12114/j.issn.1008-5971.2023.00.018

Funds：

宁夏回族自治区重点研发计划一般项目（2018YBZD0470）

摘要：

目的 基于弥散张量成像（DTI）参数分析阻塞性睡眠呼吸暂停低通气综合征（OSAHS）及其合并缺血性脑卒中患者脑白质损伤情况。方法 选取2020年11月至2021年11月于宁夏医科大学总医院神经内科和呼吸内科就诊的OSAHS合并缺血性脑卒中患者17例（OSAHS合并缺血性脑卒中组）和单纯OSAHS患者21例（OSAHS组）为研究对象。根据OSAHS病情严重程度，将OSAHS组进一步分为轻度亚组（6例）和中重度亚组（15例）。比较OSAHS组与OSAHS合并缺血性脑卒中组、轻度亚组与中重度亚组不同部位DTI参数[各向异性分数（FA）、表观弥散系数（ADC）]及OSAHS合并缺血性脑卒中组梗死区与镜像区DTI参数。结果 OSAHS合并缺血性脑卒中组左侧大脑脚、丘脑、侧脑室后角周围白质、半卵圆中心及右侧半卵圆中心、额叶FA小于OSAHS组，左侧大脑脚、内囊前肢、丘脑、半卵圆中心、额叶及右侧大脑脚、丘脑、前扣带回、半卵圆中心、额叶ADC大于OSAHS组（P<0.05）。中重度亚组左侧侧脑室前角周围白质、胼胝体压部FA大于轻度亚组，右侧额叶ADC小于轻度亚组，胼胝体压部ADC大于轻度亚组（P<0.05）。OSAHS合并缺血性脑卒中组梗死区FA小于镜像区，ADC大于镜像区（P<0.05）。结论 OSAHS合并缺血性脑卒中患者的脑白质损伤程度重于单纯OSAHS患者，其中以双侧大脑脚、丘脑、半卵圆中心、额叶为著；OSAHS合并缺血性脑卒中患者梗死区的脑白质损伤程度较重。

Abstract：

Objective To analyze the white matter injury in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and OSAHS complicated with ischemic stroke based on diffusion tensor imaging (DTI) parameters. Methods Seventeen patients with OSAHS complicated with ischemic stroke (OSAHS combined with ischemic stroke group) and 21 patients with OSAHS alone (OSAHS group) who were admitted to the Department of Neurology and Respiratory Medicine of General Hospital of Ningxia Medical University from November 2020 to November 2021 were selected as the study subjects. According to the severity of OSAHS, the OSAHS group was further divided into mild subgroup (6 cases) and moderate severe subgroup (15 cases) . The DTI parameters [fractional anisotropy (FA) , apparent diffusion coefficient (ADC) ] in different parts were compared between OSAHS group and OSAHS combined with ischemic stroke group, mild subgroup and moderate severe subgroup, and the DTI parameters in OSAHS combined with ischemic stroke group were compared between infarction area and mirror area. Results FA of left cerebral peduncle, thalamus, white matter around the posterior horn of lateral ventricle and centrum semiovale, right centrum semiovale and frontal lobe in OSAHS combined with ischemic stroke group was smaller than that in OSAHS group, ADC of left cerebral peduncle, anterior limb of internal capsule, thalamus, centrum semiovale and frontal lobe, right cerebral peduncle, thalamus, anterior cingulated gyrus, centrum semiovale and frontal lobe in OSAHS combined with ischemic stroke group was larger than that in OSAHS group (P < 0.05) . FA of left white matter around anterior horn of lateral ventricle and splenium of corpus callosum in the moderate severe subgroup was larger than that in the mild subgroup, ADC in the right frontal lobe was smaller than that in the mild subgroup, and ADC in the splenium of corpus callosum was larger than that in the mild subgroup (P < 0.05) . In OSAHS combined with ischemic stroke group, FA in infarction area was smaller than that in mirror area, and ADC was larger than that in mirror area (P < 0.05) . Conclusion The degree of white matter injury in patients with OSAHS combined with ischemic stroke was more severe than that in simple OSAHS patients, especially in bilateral cerebral peduncle, thalamus, centrum semiovale and frontal lobe. The degree of white matter injury in the infarction area of patients with OSAHS combined with ischemic stroke is relatively serious.

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