本文選題：實驗性自身性免疫性腦脊髓炎　切入點：鐵　出處：《重慶醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：第一部分磁共振成像觀察實驗性自身免疫性腦脊髓炎動物模型腦內鐵沉積的研究 目的 采用3-D增強型T*2加權血管成像(ESWAN)序列觀察實驗性自身免疫性腦脊髓炎（EAE）動物模型腦內病灶鐵沉積的情況，為多發(fā)性硬化(MS)的鐵異常沉積的機制研究提供依據。 方法 制備EAE大鼠模型15只和對照組15只；在EAE模型發(fā)病的初發(fā)期（出現(xiàn)癥狀）及高峰期，，對EAE組和對照組分別行常規(guī)T1WI、T2WI和ESWAN掃描，接著在其尾靜脈內注入Gd-DTPA，5分鐘后行增強T1WI，掃描完畢后立即處死EAE大鼠和對照組大鼠，取其腦組織，行HE染色和Prussian blue染色。 結果 EAE模型組第13天時出現(xiàn)癥狀為初發(fā)期、第17天達到癥狀高峰期；MRI檢查：增強T1WI可見病灶明顯強化；ESWAN相位圖顯示相應病灶區(qū)呈低信號；病理檢查：HE染色可見病灶區(qū)血管周圍的炎癥細胞；Prussian blue染色病灶區(qū)血管周圍巨噬細胞內未見明顯的藍染顆粒。 結論 本實驗成功制備了急性EAE動物模型，采用Prussian blue染色沒有發(fā)現(xiàn)大腦病灶區(qū)明顯的鐵沉積，可能主要與EAE動物模型病程較短及與感興趣區(qū)選擇部位有關，推測較長的病程可能更適合觀察病灶內鐵的沉積。 第二部分MRI對復發(fā)-緩解型多發(fā)性硬化患者中央前回灰質鐵沉積的研究 第一節(jié)復發(fā)-緩解型多發(fā)性硬化患者中央前回灰質的鐵沉積ESWAN定量研究 目的 利用3.0T MRI3-D增強型T*2加權血管成像(ESWAN)序列觀察復發(fā)-緩解型多發(fā)性硬化(RRMS)患者中央前回灰質鐵沉積及其與中央前回體積、臨床參數的相關性。 方法 收集RRMS患者30例及性別、年齡相匹配的正常對照組30例，在相位圖上測量中央前回灰質鐵沉積，采用平均相位值（MPV）表示，分析兩組中央前回灰質MPV值有無差異，并比較其與中央前回體積、病程及臨床EDSS評分的相關性。 結果 1) RRMS組和對照組中央前回MPV值分別為2033.13±14.39、2236.88±137.86；兩組中央前回體積分別為2201.34±78.71（mm3）、2339.15±130.09（mm3）。 2) RRMS患者中央前回灰質MPV值和對照組相比有統(tǒng)計學差異(t=-8.05, P＜0.05)；中央前回體積與對照組相比有統(tǒng)計學差異(t=-4.96, P＜0.05)。 3) RRMS患者中央前回灰質MPV值與中央前回體積呈正相關(rs=0.364, P=0.048)，與病程呈負相關(rs=-0.369, P=0.045)，與EDSS評分無相關性(rs=-0.076, P＞0.05)，與復發(fā)次數呈負相關（rs=-0.367，P＜0.05)。 結論 RRMS患者與對照組相比，中央前回灰質鐵異常沉積增加，鐵將來可能成為一種新的生物學指標。 第二節(jié)MRI縱向觀察復發(fā)-緩解型多發(fā)性硬化患者中央前回灰質鐵沉積 目的 應用3.0T MRI3-D增強型T*2加權血管成像(ESWAN)序列縱向觀察復發(fā)-緩解型多發(fā)性硬化(RRMS)患者中央前回灰質鐵沉積的動態(tài)變化及其與中央前回體積、臨床參數的相關性。 方法 縱向隨訪RRMS患者30例，進行兩次常規(guī)MR、ESWAN及軸位3D T1WI掃描，間隔1年，測量中央前回灰質鐵沉積，用平均相位值（MPV）表示，比較兩次中央前回灰質MPV值和中央前回體積的變化，分析中央前回MPV值與中央前回體積、臨床EDSS評分及病程的相關性。 結果 1)30例RRMS患者兩次測量中央前回灰質MPV值分別為（2033.131±14.39）和（2022.65±17.94），差異有統(tǒng)計學意義（P＜0.05）。兩次測量中央前回體積分別為（2307.82±109.24）和（2216.82±118.70）mm3，差異無統(tǒng)計學意義（P＞0.05）。 2)前后兩次測量中央前回灰質MPV值與中央前回體積均呈正相關(rs=0.764、0.592，P均＜0.05）；兩次中央前回灰質MPV的差值與兩次中央前回體積的差值呈正相關(rs=0.582， P＜0.05）。 3)兩次EDSS評分的差值與兩次中央前回體積的差值呈負相關(rs=-0.587， P＜0.05)，與兩次中央前回灰質MPV的差值無相關性(P＞0.05)。 4)病程與第2次測量中央前回灰質MPV值呈負相關(rs=-0.399，P＜0.05)；復發(fā)次數與兩次MPV的差值呈負相關（rs=-0.367，P＜0.05）。 結論 RRMS患者中央前回灰質鐵異常沉積隨著病程進展而增加，且隨著復發(fā)次數的增加而增加。
[Abstract]:The study of iron deposition in the brain of experimental autoimmune encephalomyelitis model in the first part of the magnetic resonance imaging
objective
3-D enhanced T*2 weighted angiography (ESWAN) sequence was used to observe the deposition of iron in the brain of experimental autoimmune encephalomyelitis (EAE) animal models, so as to provide evidence for the mechanism of iron deposition in multiple sclerosis (MS).
Method
Preparation of model 15 EAE rats and 15 rats in the control group; in the EAE model in the pathogenesis of early stage (symptoms) and the peak of the EAE group and the control group were treated with conventional T1WI, T2WI and ESWAN scan, then Gd-DTPA into the tail vein within 5 minutes after enhanced T1WI scan immediately after EAE rats were killed and the rats in the control group, the brain tissue, HE staining and Prussian blue staining.
Result
There is at the beginning of symptoms of EAE model group at thirteenth days, seventeenth days to reach the peak of symptoms: enhanced T1WI examination; MRI visible lesions showed obvious enhancement; ESWAN phase diagram shows the corresponding lesions showed low signal; pathological examination: peripheral vascular lesions visible inflammatory cells HE staining; Prussian staining of blue lesions were not found in perivascular macrophages the obvious blue dye particles.
conclusion
The animal model of acute EAE we successfully prepared using Prussian blue staining, no obvious lesion of brain iron deposition may be found, mainly with EAE animal model was shorter and the region of interest selection is related to the position, that may be more suitable for long duration observed in iron deposition lesions.
Second part MRI in the study of gray iron deposit in the central precentral gyrus of relapsed remission patients with multiple sclerosis
ESWAN quantitative study on iron deposition in precentral gray matter in patients with relapsed remission type multiple sclerosis
objective
Using 3.0T MRI3-D enhanced T*2 weighted angiography (ESWAN) sequence, we observed iron deposition in the central prefrontal gyrus and its correlation with central anterior volume and clinical parameters in patients with relapsing remitting multiple sclerosis (RRMS).
Method
We collected 30 patients with RRMS and gender, age matched normal control group of 30 cases, the measurement of anterior central gyrus gray iron deposition in the phase diagram, the average phase value (MPV), analysis of two groups of precentral gyrus gray matter MPV values had no difference, and compared with the precentral gyrus volume, disease history clinical and EDSS score.
Result
1) the MPV values in the central anterior gyrus of RRMS group and control group were 2033.13 + 14.392236.88 + 137.86, and two cases of central anterior gyrus volume were 2201.34 + 78.71 (mm3), 2339.15 + 130.09 (mm3), respectively.
2) the MPV value of gray matter in the central anterior gyrus of RRMS patients was statistically different from that in the control group (t=-8.05, P < 0.05). The volume of the anterior central gyrus was significantly different from that in the control group (t=-4.96, P < 0.05).
3) in RRMS patients, there was a positive correlation between MPV value in central prefrontal gyrus and the volume of anterior central gyrus (rs=0.364, P=0.048), which was negatively correlated with the course of disease (rs=-0.369, P=0.045), and had no correlation with EDSS score (rs=-0.076, P > 0.05), and negatively correlated with the number of relapses (rs=-0.367, P < 0.05).
conclusion
Compared with the control group, the abnormal deposition of gray iron in the central precentral gyrus increased, and iron may become a new biological indicator in the future.
Second section MRI longitudinal observation of central precentral gray iron deposition in recurrent remission patients with multiple sclerosis
objective
3.0T MRI3-D enhanced T*2 weighted angiography (ESWAN) sequence was used to observe the dynamic changes of iron deposition in the central prefrontal gyrus of patients with relapsing remitting multiple sclerosis (RRMS) and its correlation with central anterior volume and clinical parameters.
Method
30 cases of RRMS patients with longitudinal follow-up, two times of conventional MR, ESWAN and T1WI axial 3D scanning, 1 years apart, measuring the precentral gyrus gray iron deposition, with the average phase value (MPV), two times the precentral gyrus and precentral gyrus gray matter MPV volume changes, analysis of the precentral gyrus MPV the value and volume of the precentral gyrus, the correlation between clinical EDSS score and clinical course.
Result
1) in 30 cases of RRMS, the MPV value of gray matter in the anterior central gyrus was two times (2033.131 + 14.39) and (2022.65 + 17.94) in two times. The difference was statistically significant (P < 0.05). The volume of the central anterior gyrus measured by two times was 2307.82 (2307.82) 109.24 and (109.24 + two), respectively, and the difference was not statistically significant (P > rainfall).
2) before and after two measurements, the gray matter MPV value of the central anterior gyrus was positively correlated with the volume of the central anterior gyrus (rs=0.764,0.592, P < 0.05); the difference between the gray matter MPV of the two central anterior gyrus and the two central anterior volume was positively correlated (rs=0.582, P < 0.05).
3) there was a negative correlation between the difference between the two EDSS scores and the two central anterior loop volume (rs=-0.587, P < 0.05), and there was no correlation between the difference between the two time and the two precentral gyrus gray matter (P > 0.05).
4) the course of the disease was negatively correlated with the MPV value of the second times in the central anterior gyrus (rs=-0.399, P < 0.05), and the difference between the recurrence times and the two MPV was negatively correlated (rs=-0.367, P < 0.05).
conclusion
The abnormal deposition of gray iron in the precentral gyrus of RRMS patients increased with the progression of the disease, and increased with the increase of the number of relapses.

【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.2;R744.51

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