摘要
目的应用静息态功能磁共振(rs-fMRI)探讨失眠障碍患者大脑半球间同伦功能连通性。方法回顾性选择2017年9月至2019年4月在甘肃省人民医院睡眠医学中心就诊的失眠障碍患者54例为病例组,男16例、女38例,年龄(42±12)岁。招募健康志愿者56名为健康对照组,男21名、女35名,年龄(38±11)岁。病例组行多导睡眠监测,所有受试者行神经心理量表评估和rs-fMRI扫描。计算基于体素的镜像同伦连接(VMHC)和基于种子点的功能连接,统计比较两组的组间差异,与失眠病程、神经心理量表和多导睡眠监测行相关分析,并以受试者工作特征(ROC)曲线评价rs-fMRI各参数对失眠障碍的诊断效能。结果病例组双侧颞中回VMHC低于健康对照组(t=-4.276,P<0.05)。左侧颞中回与右侧丘脑/中扣带回、左侧丘脑、右侧小脑小叶Ⅳ~Ⅴ及左侧小脑小叶Ⅷ(t=4.719、5.297、6.044、4.129,均P<0.05)间的功能连接增强,与对侧颞中回(t=-4.139,P<0.05)间功能连接减弱。病例组颞中回的VMHC值与简易智能精神状态检查(r=0.288,P=0.035)、蒙特利尔认知评分(r=0.283,P=0.038)呈显著正相关;左侧颞中回与右侧小脑小叶Ⅳ~Ⅴ间功能连接与睡眠潜伏期呈正相关(r=0.302,P=0.027)。左侧颞中回与右侧丘脑/中扣带回间的功能连接对失眠障碍的诊断效能最高,其ROC曲线下面积为0.814。结论失眠障碍患者存在半球间信息交流和整合障碍,双侧颞中回的半球间协同性受损及其与多个脑区间的功能连接异常可能是其认知功能障碍的重要神经病理机制及神经影像学生物标记。
Objective To explore the interhemispheric functional connectivity in patients with insomnia disorder using resting-state functional magnetic resonance imaging(rs-fMRI).Methods Fifty-four insomnia disorder patients were collected in Gansu Province Hospital from September 2017 to April 2019 as patient group,16 males and 38 females,with an average age of(42±12)years old.Fifty-six healthy subjects were recruited as control group,21 males and 35 females,with an average age of(38±11)years old.Polysomnography(PSG)was performed for patient group.All participants underwent neuropsychological assessments and rs-fMRI scan.The voxel-mirrored homotopic connectivity(VMHC)and the seed-based functional connectivity were calculated,and the differences between the two groups were compared.Correlation analysis was performed between the significant brain area for VMHC and FC with the duration of illness,neuropsychological scale and PSG parameters,and receiver operating characteristic(ROC)curve was used to evaluate the rs-fMRI parameters in diagnostic efficiency in insomnia disorder.Results The VMHC of bilateral middle temporal gyrus(MTG)were significantly lower in patients group than those in healthy controls(t=-4.276,P<0.05).FC were increased between left MTG with right thalamus/middle cingulate gyrus,left thalamus,right cerebellar lobuleⅣ-Ⅴand left cerebellar lobuleⅧ(t=4.719,5.297,6.044,4.129,all P<0.05),and decreased between left MTG and right MTG(t=-4.139,P<0.05).There were significantly positive correlations between the MTG VMHC values and mini-mental state examination(r=0.288,P=0.035)or montreal cognitive assessments scores(r=0.283,P=0.038),and also between the FC of the left MTG-right cerebellar lobuleⅣ-Ⅴand sleep onset latency(r=0.302,P=0.027).The FC between the left MTG-right thalamus/medial cingulate gyrus presented highest diagnostic efficiency for insomnia with an area under the ROC curve(AUC)of 0.814.Conclusion Insomnia disorder patients have impairment of interhemispheric information interaction and integration.Impairment of interhemispheric coordination and abnormal FC of MTG might be important neuropathologic mechanism and neuroimaging biomarkers for cognitive dysfunction in patients with insomnia disorder.
作者
方燕燕
赵莲萍
黄刚
张文文
谢宇平
苏晓艳
梁丰丽
高艳艳
陆亚姗
Fang Yanyan;Zhao Lianping;Huang Gang;Zhang Wenwen;Xie Yuping;Su Xiaoyan;Liang Fengli;Gao Yanyan;Lu Yashan(Department of Radiology,Gansu Province Hospital,Lanzhou 730000,China;Sleep Medicine Center,Gansu Province Hospital,Lanzhou 730000,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第19期1484-1489,共6页
National Medical Journal of China
基金
睡眠障碍神经影像机制研究甘肃省国际科技合作基地。
关键词
入睡和睡眠障碍
磁共振成像
脑损害
慢性
Sleep initiation and maintenance disorders
Magnetic resonance imaging
Brain damage
Chronic
