贫血患者大脑静息葡萄糖代谢改变的研究

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。

Changes in resting-state brain glucose metabolism in patients with anemia

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.