CAJ | 학술논문

目的分析图雷特综合征(TS)患者在运动切换时脑激活特点,初步探讨TS患者抽动触发的可能机制.方法 14例TS患者(TS组)和14名年龄、性别相匹配的健康志愿者(对照组),用3.0T超导磁共振扫描系统进行功能MRI扫描,对比分析在对指运动转换过程中TS患者和健康志愿者的脑激活特点.结果两组受试者激活相同的脑区:对侧的中央前后回、对侧扣带回、对侧额叶内侧回、同侧小脑半球；激活不同的脑区:附加右手对指运动时,左侧中央前后回激活体积( cm3) TS组(8.024±0.071)大于对照组(6.480±0.026),两者差异有统计学意义(t=3.026,P＜0.01)；附加左手对指运动时,TS组(6.192±0.019)右侧中央前后回的激活体积大于对照组(5.608±0.037),两者差异有统计学意义(t=2.752,P＜0.05)；TS组无岛叶激活,对照组出现对侧岛叶激活；TS组出现对侧丘脑激活,而对照组无丘脑激活.结论丘脑在TS的发病机制中具有重要的作用,岛叶、扣带回、顶叶皮质环路可能是异样感觉和抽动发作前驱不适的结构和功能基础,TS患者从静止到运动的触发启动和(或)与一种运动到另一种运动的触发启动所需要的条件功能区可能存在差异.
목적 분석도뢰특종합정(TS)환자재운동절환시뇌격활특점,초보탐토TS환자추동촉발적가능궤제.방법 14례TS환자(TS조)화14명년령、성별상필배적건강지원자(대조조),용3.0T초도자공진소묘계통진행공능MRI소묘,대비분석재대지운동전환과정중TS환자화건강지원자적뇌격활특점.결과 량조수시자격활상동적뇌구:대측적중앙전후회、대측구대회、대측액협내측회、동측소뇌반구；격활불동적뇌구:부가우수대지운동시,좌측중앙전후회격활체적( cm3) TS조(8.024±0.071)대우대조조(6.480±0.026),량자차이유통계학의의(t=3.026,P＜0.01)；부가좌수대지운동시,TS조(6.192±0.019)우측중앙전후회적격활체적대우대조조(5.608±0.037),량자차이유통계학의의(t=2.752,P＜0.05)；TS조무도협격활,대조조출현대측도협격활；TS조출현대측구뇌격활,이대조조무구뇌격활.결론 구뇌재TS적발병궤제중구유중요적작용,도협、구대회、정협피질배로가능시이양감각화추동발작전구불괄적결구화공능기출,TS환자종정지도운동적촉발계동화(혹)여일충운동도령일충운동적촉발계동소수요적조건공능구가능존재차이.
Objective To investigate the central nervous system mechanisms of active of movement switch in the patients with Tourette' s syndrome( TS),and to explore the possible underlying distinct neural networks for tic trigger and generation. Methods Participants were 14 patients with TS and 14 age- and gender-matched healthy volunteers with no history of physical,psychiatric or neurological disease: All patients were assessed with functional magnetic resonances imaging (fMRI) of the brain during the intermittent performance of finger-tapping switch tasks,Blood-oxygen-level dependent-fMRI was performed using a 3.0 Tesla MR.The area over which the activation was distributed was calculated,and the activation volumes were also compared between the patients with TS and the control subjects.Results The regions activated in the patients with TS and in the volunteers were similar in several brain regions,including contralateral precentral and postcentral gyrus,contralateral mesia pre-front gyrus,contralateral cingulate gyrus,contralateral insula and ipsilataral cerebellum. There were also many different activation areas between the patients and the control subjects. The patients with TS demonstrated more significant and extended activation in the contralateral pre- and postcentral gyrus than the healthy volunteers.The volume of the left pre- and postcentral gyrus of the TS patients was (8.024 ±0.071 ) cm3,while the volume of the left pre-and postcentral gyrus of the control subjects was ( 6.480 ± 0.026) cm3 ( t =3.026,P ＜ 0.01 ) ; The volume of the right pre- and postcentral gyrus was (6.192 ± 0.019) cm3 in the TS cases,while there was (5.608 ±0.037) cm3 in the control subjects (t =2.752,P ＜0.05).There were significant differences in the volumes of bilateral pre- and postcetral gyrus between the TS and control subjects. The activations of conralateral thalamus without contralateral insula were found in the patients with TS. Conversely, the contralateral insula activation without thalamus activation could be found in the healthy volunteers.Conclusion The thalamus might play an important role in the aetiological and physiopathologic mechanisms of the TS. The thalamus along with the parietal cortex,cingulate cortex and insular cortex appear to constitute a distinct neural network for tic trigger and generation.