原发性失眠患者脑结构及静息态脑功能连接的磁共振研究

发布时间：2018-05-12 22:45

  本文选题：原发性失眠 + 基于体素的形态学测量　； 参考：《郑州大学》2014年硕士论文

【摘要】：目的 应用基于体素的形态学测量（voxel-based morphometry，VBM）技术和静息态功能连接磁共振（resting state functional connectivity magnetic resonanceimaging，rs-fcMRI）技术方法，研究原发性失眠（primary insomnia，PI）患者脑结构和功能连接的改变，探讨原发性失眠异常生物学特性和抑郁障碍可能存在的脑结构及脑功能连接异常的病理生理机制，为PI的临床诊断、治疗提供影像学依据。 资料与方法 30例未经治疗的原发性失眠患者且符合《美国精神障碍诊断和统计手册第四版》（DSM-IV）诊断标准，其中有15例PI伴有轻中度抑郁症状（primaryinsomnia with depression，PID）与15名的正常对照组（normal control，NC）进行三维脑结构和静息态血氧水平依赖功能磁共振成像检查。所有受试者进行临床量表（匹兹堡睡眠质量指数PSQI、汉密尔顿焦虑量表HAMA、汉密尔顿抑郁量表HAMD和Rey复杂图形测试RCFT）的测评。所得扫描数据通过Matlab软件上SPM8（statistical parametric maps）进行VBM脑结构形态学分析，比较三组受试者脑灰质结构的差异；使用REST软件以双侧前扣带回为种子点进行静息态脑功能连接分析，比较三组之间脑功能连接的差异；使用SPSS17.0软件包进行统计分析，对异常脑功能连接区与各量表评分进行相关性分析。 结果 1一般资料三组的性别、年龄及受教育程度比较均无统计学差异（P＞0.05）。 2VBM显示 1、与NC比较，PI患者的双侧额叶皮质、颞叶皮质、楔前叶、前扣带回、脑岛、尾状核、左侧豆状核、顶上回、中央旁小叶、枕中回、海马、海马旁回、小脑脚及右侧梭状回、边缘叶/后扣带回体积减少，左侧颞中回体积增大（P＜0.001，簇大小cluster＞50voxels）。 2、与NC比较，PID患者双侧额上回/补充运动区、颞叶皮质、边缘叶/前扣带回、楔前叶、小脑后叶/小脑8区、左侧梭状回、枕叶皮质、小脑前叶及右侧内侧额上回、岛盖部额下回、角回/缘上回体积减少，双侧顶叶/中央后回、左侧额中回、中央前后回、脑干/中脑及右侧颞叶/Sub-Gyral、枕叶/舌回、边缘叶/海马旁回体积增大（P＜0.001，簇大小cluster＞50voxels）。 3、与PI患者比较，PID患者左侧三角部额下回、颞下回、小脑后叶/小脑8区、小脑10区及右侧额上回/补充运动区、额下回、角回/颞上回、颞叶/Sub-Gyral体积减小，双侧额上回/补充运动区、颞叶皮质、楔前叶、小脑后叶/小脑8区、左侧梭状回、中央旁小叶、枕叶皮质、前扣带回和旁扣带回、小脑前叶及右侧颞中回/三角部额下回、前扣带回/额中回、颞下回、角回/缘上回体积增大（P＜0.001，簇大小cluster＞50voxels）。 3RS-fcMRI显示 3.1以双侧前扣带回为种子点进行脑功能连接分析 1、NC的脑功能连接神经网络包括双侧额叶皮质、双侧顶叶/角回、右侧缘上回/颞上回、左侧间脑/内侧和旁扣带脑回、右侧边缘叶/楔前叶/扣带回、左侧边缘叶/海马旁回、左侧尾状核/脑岛/豆状核/前扣带和旁扣带脑回、双侧颞叶皮质与前扣带回呈正相关；双侧局部额叶皮质、右侧顶叶皮质、右侧枕中回/枕上回、左侧颞下回/梭状回/枕中回、右侧枕叶/梭状回/舌回/颞下回、左侧小脑半球与前扣带回呈负相关（P＜0.01，体素簇＞20voxels）。 2、PI患者的异常脑功能神经网络包括左侧额叶/额中回、双侧顶叶皮质、左侧颞下回/枕下回/枕中回、右侧小脑半球与前扣带回呈负相关；左侧前扣带回/额上回/内侧额上回/尾状核/豆状核/眶部额下回/脑岛、双侧颞下回/颞中回、左侧顶叶/角回、左侧顶叶/楔前叶/后扣带回、右侧边缘叶/扣带回/内侧和旁扣带脑回与前扣带回呈正相关（P＜0.01，体素簇＞20voxels）。 3、PID患者的异常脑功能神经网络包括双侧顶上小叶/顶下回/顶上回、左侧楔前叶、左侧额中回/中央前回、左侧枕中回/枕下回、右侧小脑后叶/下半月小叶/小脑7b区与前扣带回呈负相关；左侧顶叶/角回/缘上回、左侧后扣带回/楔前叶、右侧尾状核头/尾状核、左侧额中回/前扣带回/额上回/前扣带和旁扣带脑回/内侧额上回/内侧和旁扣带回/中央旁小叶与前扣带回呈正相关（P＜0.01，体素簇＞20voxels）。 4、与NC比较，PI患者与前扣带回功能连接负相关脑区有右侧颞下回、右侧顶上回/顶上小叶/顶下小叶、左侧边缘叶/扣带回，与前扣带回功能连接正相关脑区有左侧小脑前叶/山顶/舌回（P＜0.01，体素簇＞20voxels）。 5、与NC比较，PID患者与前扣带回功能连接负相关脑区有脑干/中脑、左侧颞中回、左侧小脑后叶/小脑Crus1区，与前扣带回功能连接正相关脑区有左侧顶叶/Sub-Gyral/中央沟盖、左侧额叶/Sub-Gyral/三角部额下回、右侧顶叶/枕中回、右侧顶上回（P＜0.01，体素簇＞20voxels）。 6、与PI患者比较，PID患者左侧胼胝体/后扣带回与前扣带回功能连接负相关，中脑右份与前扣带回功能连接正相关（P＜0.01，体素簇＞20voxels）。 3.2相关性分析 1、PI患者与NC组脑功能连接异常区：左侧扣带回、左侧舌回、右侧颞下回、右侧顶上回功能连接与PSQI值无明显相关性（P＞0.05）。 2、PID患者与NC组脑功能连接异常区：中脑、左侧颞中回、左侧小脑Crus1区功能连接与PSQI值呈明显负相关性（P＜0.05），左侧中央沟盖、左侧三角部额下回、右侧枕中回、右侧顶上回功能连接与其无明显关联性（P＞0.05）。除了右侧顶上回功能连接的程度与HAMD值呈正相关（P＜0.05），其他脑功能连接异常区与其无明显相关性（P＞0.05）。 3、PID患者与PI患者脑功能连接异常区：左侧后扣带回功能连接与HAMD值呈正相关性（P＜0.05），中脑右份与HAMD值无明显关联性（P＞0.05）。结论 与NC比较，PI患者与PID均有脑结构及脑功能连接的改变，这些可能与原发性失眠的病理生物学机制有关；PI患者左侧前扣带回/脑岛、左侧后扣带回、右侧边缘叶/扣带回/内侧和旁扣带脑回与ACC连接增强，与PI患者比较，，PID患者左侧胼胝体/后扣带回与ACC功能连接减弱，额叶、边缘叶与ACC功能连接增强，这些均支持了PI患者伴发抑郁情绪会存在异常的脑网络连接；VBM及RS-fcMRI准确有效的评价PI患者脑形态学和功能状态的改变，为PI的神经认知科学领域的研究提供了影像解剖学基础。
[Abstract]:Purpose

Based on voxel - based morphological measurements ( VBM ) and resting state functional connectivity magnetic resonance ( rs - fcMRI ) , the changes of brain structure and function were studied in primary insomnia ( PI ) patients .

data and methods

Thirty patients with primary insomnia who were untreated and conformed to the diagnostic criteria of the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders ( DSM - IV ) in the United States . Among them , 15 patients with PI accompanied with mild to moderate depressive symptoms ( PID ) and 15 normal control ( NC ) were tested for three - dimensional brain structure and resting state blood oxygen level dependent functional magnetic resonance imaging . All subjects underwent a clinical rating scale ( Pittsburgh Sleep Quality Index , PSQI , Hamilton Anxiety Scale HAMA , Hamilton Depression Scale ) and Rey Complex Graphic Test ( RTs ) . The obtained scan data were analyzed by means of SPM8 ( statistical parametric maps ) on Matlab software to compare the differences in the structure of cerebral gray matter in three groups of subjects ;
Using REST software to carry out the resting state brain function connection analysis of two - sided front - button gyrus as seed point , and compare the difference of functional connections among three groups ;
Statistical analysis was carried out using SPSS 17.0 software package , and the correlation between abnormal brain function connecting area and each scale score was analyzed .

Results

There was no significant difference in sex , age and educational level among the three groups ( P > 0.05 ) .

2VBM display

1 . Compared with NC , PI patients had bilateral frontal cortex , temporal lobe cortex , anterior wedge lobe , anterior subulate gyrus , cerebral island , tail nucleus , left bean nucleus , top gyrus , central parlobule , middle gyrus , hippocampus , parahippocampal gyrus , cerebellar peduncle and right fusiform gyrus . The volume of left temporal gyrus increased ( P & lt ; 0.001 , cluster size cluster & gt ; 50 掳 ) .

2 . Compared with NC , the double - lateral frontal / supplementary sports area of PID patients , temporal lobe cortex , marginal leaf / anterior subulate gyrus , wedge anterior lobe , posterior lobe of cerebellum , frontal gyrus , left fusiform gyrus , occipital lobe cortex , cerebellum anterior lobe and right medial frontal gyrus , bilateral parietal / central gyrus , left frontal gyrus , posterior central gyrus , brainstem / midbrain and right temporal lobe / Sub - Gyral , occipital lobe / lingual gyrus , marginal leaf / hippocampus bypass volume increased ( P < 0.001 , cluster size cluster > 50惟 ) .

3 . Compared with PI patients , the left triangle frontal gyrus , temporal gyrus , cerebellum posterior lobe / cerebellum 8 area , cerebellum 10 area and right frontal gyrus / supplementary sports area , frontal gyrus , angle gyrus / temporal gyrus , temporal lobe / sub - Gyral volume decrease , bilateral frontal gyrus / supplementary sports area , left fusiform gyrus , posterior central lobule , occipital lobe cortex , anterior and posterior subulate gyrus , anterior buckle gyrus / frontal gyrus , temporal gyrus , angle gyrus / margin increase ( P < 0.001 , cluster size cluster & gt ; 50渭m ) .

3RS - fcMRI Display

3.1 Analysis of brain function connection with two - sided front - button - back as seed point

1 . NC ' s brain function connection neural network includes bilateral frontal lobe cortex , bilateral parietal lobe / angle gyrus , right margin upper gyrus / temporal gyrus , left lateral cerebral / medial side and side buckle , right margin leaf / wedge anterior leaflet / buckle back , left margin leaf / hippocampus bypass , left tail nucleus / brain island / bean nucleus / anterior buckle belt and side buckle belt brain gyrus , and bilateral temporal lobe cortex is positively correlated with anterior buckle back ;
Bilateral local frontal cortex , right parietal cortex , right occipital gyrus / occipital gyrus , left temporal gyrus / fusiform gyrus / occipital gyrus , right occipital lobe / fusiform gyrus / lingual gyrus / temporal gyrus , left cerebellar hemisphere were negatively correlated with anterior buckle ( P & lt ; 0.01 , voxel cluster & gt ; 20 ) .

2 . The abnormal brain function neural network of PI patients included left frontal lobe / frontal gyrus , bilateral parietal cortex , left temporal gyrus / occipital gyrus / pillow middle gyrus , right cerebellar hemisphere and anterior buckle gyrus ;
Left anterior buckle / frontal gyrus / medial frontal / medial frontal / medial frontal / medial frontal gyrus / brain island , bilateral temporal gyrus / temporal gyrus , left parietal / corner gyrus , left parietal lobe / anterior leaflet / posterior buckle , right edge leaf / buckle back / medial and side buckle gyrus were positively correlated ( P & lt ; 0.01 , voxel cluster & gt ; 20 ) .

3 . The abnormal brain function neural network of PID patients consisted of bilateral parietal lobule / top gyrus / top gyrus , left wedge anterior lobe , left frontal gyrus / central anterior gyrus , left occipital gyrus / occipital gyrus , right cerebellum posterior leaflet / inferior lobe / cerebellum 7b area and anterior buckle back ;
The left parietal lobe / corner return / margin , the left rear retaining / wedge front lobe , the right tail nucleus / tail nucleus , the left frontal gyrus / anterior buckle / frontal gyrus / frontal gyrus / medial frontal gyrus / medial frontal gyrus / medial frontal gyrus / medial collateral gyrus / medial collateral lobe were positively correlated with the anterior buckle ( P & lt ; 0.01 , voxel cluster & gt ; 20 ) .

4 . Compared with NC , PI patients had a negative correlation with the anterior buckle back function , the right temporal gyrus , right parietal lobule / apical inferior lobule , left margin leaf / button gyrus , and the frontal gyrus function were connected with the left cerebellum anterior lobe / hilltop / lingual gyrus ( P & lt ; 0.01 , voxel cluster & gt ; 2010a ) .

5 . Compared with NC , the patients with PID were connected with the function of anterior buckle and gyrus with brain stem / midbrain , left temporal gyrus , left cerebellum posterior lobe / cerebellum 1 region , and the left parietal lobe / Sub - Gyral / central sulcus cover , left frontal lobe / Sub - Gyral / triangular frontal gyrus , left frontal lobe / pillow middle gyrus , right parietal lobe / pillow gyrus ( P < 0.01 , voxel cluster & gt ; 2010a ) .

6 . Compared with PI patients , the left corpus callosal / posterior subulate gyrus of PID patients was negatively correlated with the function of anterior buckle and the right of middle cerebral cortex was positively correlated with the function of anterior buckle back ( P < 0.01 , voxel cluster & gt ; 20 ) .

3.2 Correlation Analysis

1 . There was no significant correlation between PI patients and NC group ' s brain function : left button gyrus , left lingual gyrus , right temporal gyrus , right top gyrus function connection and PSQI value ( P > 0.05 ) .

2 銆

本文编号：1880482