CAJ | 학술논문

目的采用静息态fMRI(rs-fMRI)基于体素镜像同伦连接(VMHC)方法观察偏侧帕金森病(PD)患者的脑半球间功能连接的改变情况.方法共收集早期右侧发病PD(RPD) 16例,左侧发病PD(LPD) 15例,及年龄、性别和教育水平匹配的正常对照(HC) 19名,采集静息态fMRI数据.然后对数据进行预处理,采用协方差分析(ANCOVA)及两样本t检验比较并计算出LPD组与RPD组VMHC值改变的脑区[P＜0.05,多重比较(AlphaSim)联合簇≥16个体素校正],并对2组患者间VMHC差异脑区的脑半球间功能连接强度与临床特征进行Pearson相关分析.结果与对照组相比,LPD组患者在视觉皮层、感觉运动皮层、小脑皮层等部位的脑半球间功能连接强度减弱(体素大小为17 ～ 77,t值为-5.06-3.42,P值均＜0.05),而RPD组则在前额叶和感觉运动皮层的脑半球间功能连接强度降低(体素大小为26、30,t值为-4.96、-3.75,P值均＜0.05),此外,LPD组与RPD组患者在基底节区的VMHC均升高.相对于RPD组患者,LPD组患者的VMHC在视觉皮层、感觉运动皮层减低(体素大小为16、18,t值为-3.68、-3.87,P值均＜0.05),而在缘上回升高(体素大小为44,￡值为4.72,P＜0.05).基于ROI的相关分析发现,在LPD组,枕下回及中央后回的VMHC与贝克抑郁自评量表(BDI-Ⅱ)呈负相关(r值分别为-0.58、-0.59,P值均＜0.05),而与简易精神量表测试(MMSE)值呈正相关(r值分别为0.56、0.52,P值均＜0.05).在RPD组,缘上回的VMHC与病程呈正相关(r=0.56,P＜0.05),中央后回的VMHC与MMSE呈正相关(r=0.53,P＜0.05).结论 PD患者的运动症状偏侧性影响到脑半球间功能连接的模式,可能对理解偏侧PD的病理生理机制提供了一个新的视角.
목적 채용정식태fMRI(rs-fMRI)기우체소경상동륜련접(VMHC)방법관찰편측파금삼병(PD)환자적뇌반구간공능련접적개변정황.방법 공수집조기우측발병PD(RPD) 16례,좌측발병PD(LPD) 15례,급년령、성별화교육수평필배적정상대조(HC) 19명,채집정식태fMRI수거.연후대수거진행예처리,채용협방차분석(ANCOVA)급량양본t검험비교병계산출LPD조여RPD조VMHC치개변적뇌구[P＜0.05,다중비교(AlphaSim)연합족≥16개체소교정],병대2조환자간VMHC차이뇌구적뇌반구간공능련접강도여림상특정진행Pearson상관분석.결과 여대조조상비,LPD조환자재시각피층、감각운동피층、소뇌피층등부위적뇌반구간공능련접강도감약(체소대소위17 ～ 77,t치위-5.06-3.42,P치균＜0.05),이RPD조칙재전액협화감각운동피층적뇌반구간공능련접강도강저(체소대소위26、30,t치위-4.96、-3.75,P치균＜0.05),차외,LPD조여RPD조환자재기저절구적VMHC균승고.상대우RPD조환자,LPD조환자적VMHC재시각피층、감각운동피층감저(체소대소위16、18,t치위-3.68、-3.87,P치균＜0.05),이재연상회승고(체소대소위44,￡치위4.72,P＜0.05).기우ROI적상관분석발현,재LPD조,침하회급중앙후회적VMHC여패극억욱자평량표(BDI-Ⅱ)정부상관(r치분별위-0.58、-0.59,P치균＜0.05),이여간역정신량표측시(MMSE)치정정상관(r치분별위0.56、0.52,P치균＜0.05).재RPD조,연상회적VMHC여병정정정상관(r=0.56,P＜0.05),중앙후회적VMHC여MMSE정정상관(r=0.53,P＜0.05).결론 PD환자적운동증상편측성영향도뇌반구간공능련접적모식,가능대리해편측PD적병리생리궤제제공료일개신적시각.
Objective To investigate changes of the interhemispheric coordination integrity in patients with hemi-parkinsonism using resting-state functional magnetic resonance imaging(rs-fMRI) homotopy technique called voxel-mirrored homotopic connectivity(VMHC).Methods Sixteen Parkinson disease(PD) patients with right body side motor symptom onset(RPD),15 patients with left side onset(LPD),and 19 age-,gender-,and education-matched healthy controls(HC) were included in this study.rs-fMRI scanning and pre-processed the raw data were performed.Then by using analysis of variance(ANOVA) and two sample t tset,we performed VMHC analyses on rs-fMRI data of these participants(P＜0.05,corrected with AlphaSim,clusters≥16 voxels).Exploratory linear correlations analyses were performed between the VMHC of regions showing significant group differences and the clinical features of LPD or RPD patients.Results Compared with HCs,patients with LPD had significantly reduced VMHC in visual regions,sensorimotor regions,and the cerebellar cortex(voxels size of 17-77,t=-5.06--3.42,P＜0.05).Patients with RPD exhibited decreased VMHC in the prefrontal cortex and sensorimotor regions.Both LPD and RPD groups had increased VMHC in subcortical regions.When compared with the RPD group,the LPD group displayed decreased VMHC in the visual regions,sensorimotor regions(voxels=16 and 18; t=-3.68and-3.87,respectively,both P＜0.05) and increased VMHC in the supramarginal gyrus(voxels=4,t=4.72,P＜0.05);ROI-based correlation analyses indicated that the VMHC in the inferior occipital gyrus and the postcentral gyrus was negatively correlated with the BDI-Ⅱ scores in the LPD group(r=-0.58 and-0.59,respectively; both P＜0.05),and positively correlated with the MMSE scores(r=0.56 and 0.52,respectively;both P＜0.05).In the RPD group,a positive correlation was found for the VMHC in the supramarginal gyrus and the illness duration(r=0.56,P＜0.05) and for the VMHC in the postcentral gyrus and the(mini-mental state exam) MMSE(r=0.53,P＜0.05).Conclusions The differential pattern of deficits in the interhemispheric coordination integrity in hemi-parkinsonism reflected by VMHC may provide insights into the neurological pathophysiology underlying the asymmetry of symptom appearance in PD.