甲状腺功能亢进症患者记忆功能评定及脑灌注相关研究

目的比较不同病程甲状腺功能亢进症（简称甲亢）患者记忆功能状态，并探讨脑血流灌注显像在评价甲亢患者记忆功能损害中的价值。方法对37例临床确诊为甲亢的患者病例组：男10例，女27例；平均年龄（39．27±10．58）岁]、28名健康志愿者对照组：男8名，女20名；平均年龄（35．80±9．41）岁]进行前瞻性研究。病例组分成短病程组（病程≤6个月，n=15）和长病程组（病程〉6个月，n=22）。应用韦氏记忆量表评估记忆力，划消试验评估注意力，抑郁自评量表（SDS）和焦虑自评量表（SAS）评估抑郁、焦虑情绪。同日行^99Tc^m-ECDSPECT静息态脑血流灌注显像，组间脑血流灌注比较应用SPM2．0软件。采用两独立样本t检验和多元逐步回归分析进行统计学处理。结果病例组与对照组记忆量表总分（92．27±17．50与101．75±11．70）、记忆商（91．32±17．76与100．29±9．43）差异有统计学意义（t=-2．476和-2．421，均P〈0．05）。长病程患者量表总分、记忆商与对照组（88．77±16．69与101．75±11．70，86．18±16．73与100．29±9．43）比较均减低（t=-3．231和3．770，均P〈0．05）；短病程患者量表总分、记忆商与对照组差异无统计学意义（t=0．910和-0．754，均P〉0．05）。长病程患者记忆商较短病程患者明显减低（86．10±17．13与98．87±17．00；t=2．212，P〈0．05）。SPECT显像甲亢患者边缘系统存在较大范围血流灌注减低区，长病程组血流减低范围大于短病程组。多元逐步回归分析显示年龄、注意力得分、血清FT4以及左丘脑枕、左外侧膝状体、右杏仁体血流灌注减低是甲亢患者记忆力的影响因素（b=-0．393—0．685，均P〈0．05）。结论病程较长的甲亢患者记忆功能明显受损，脑血流灌注显像能够反映甲亢患者记忆受损相关脑区的功能状态。

Evaluation of the memory function and cerebral blood flow in patients with hyperthyroidism

Objective To assess the memory function of hyperthyroid patients at different disease durations and investigate the value of cerebral blood flow （CBF） imaging in the detection of memory dysfunction in related regions. Methods Thirty-seven hyperthyroid patients （ 10 males, 27 females ; mean age （39.27±10.58） years） and 28 heahhy volunteers （8 males, 20 females; mean age （35.80±9.41） years） were enrolled into this prospective study. The patients were divided into two subgroups： short duration group （ duration ≤ 6 months ; n = 15）, long duration group （ duration 〉6 months ; n = 22）. Wechsler memory scale was used for memory assessment, and cancellation test was used for attention assessment. Self-rating depressions scale （SDS） and self-rating anxiety scale （SAS） were used for mood disorder assessment. 99Tcm-ECD SPECT CBF imaging was performed at rest for all patients and controls on the same day. SPM 2.0 was used to investigate the differences of rCBF between the two groups. Two independent samples t test was used for the comparisons of memory and attention scores between patients and controls, also between patients with short and long disease durations. Multiple stepwise regression was used for factor analysis of memory state. Results Scale total score （92.27±17.50 vs 101.75±11.70; t=-2.476）and memory quotient （91.32±17.76 vs 100.29±9.43 ; t = -2.421 ） were significant different between patients and controls （ both P〈0.05 ）. The scale total score and memory quotient in patients with long disease duration were significant lower than those of controls（ 88.77±16.69 vs 101.75±11.70, t=-3.231; 86.18±16.73 vs 100.29±9.43, t=3.770, both P〈 0. 05）. The memory quotient was significant lower in patients with long disease duration than those with short disease duration（ 86.10±17.13 vs 98.87±17.00; t=2.212, P〈0.05）. There was no significant difference in memory quotient and scale total score between short duration group and controls （t=-0.754, 0.910, both P〉0.05）. CBF was reduced in the limbic system of hyperthyroid patients and the involved area was larger in patients with long disease duration. Age, attention score, serum FT4 level and reduced CBF in left pulvina nuclei, left lateral geniculate body and right amygdale were the statistically significant factors for impaired memory function in hyperthyroid patients （b =-0.393-0.685, all P〈0.05）. Conclusions Memory impairment could be significant in hyperthyroid patients with long disease duration. CBF imaging could reflect the degree of dysfunction at specific brain regions responsible for memory impairment in these patients.