CAJ | 학술논문

目的通过注意缺陷多动障碍(ADHD)儿童静息态功能磁共振成像(fMRI)后扣带回功能连接的变化从脑区间连接的角度探讨ADHD的神经机制.方法选择2008年6月至2010年4月于苏州大学附属第三医院儿童多动症门诊就诊的混合型ADHD儿童30例及同期常州市一所普通小学年龄、性别相匹配的健康对照组30名,进行静息态fMRI扫描,使用REST软件以后扣带回为感兴趣区与全脑其他区域进行功能连接分析并比较组间差异.结果 ADHD组与健康对照组内与后扣带回有显著功能连接的脑区基本一致,正性连接的脑区主要位于默认网络,负性连接的脑区主要位于背外侧前额叶、背侧前扣带回、顶下小叶、基底节区域(均P＜O.05,校正后).ADHD组后扣带回与双侧内侧前额叶、右侧后扣带回、右侧颞下回、小脑后叶的正性功能连接强度均低于健康对照组(0.07±0.20比0.33±0.23、0.25±0.28比0.48±0.30、-0.05±0.19比0.22±0.22、-0.04±0.21比0.17±0.16,t=-5.47、-3.44、-4.61、-3.99,均P＜0.05,校正后)；后扣带回与左侧岛叶、右侧顶下小叶、左侧中央后回、左侧颞上回、右侧颞上回、左侧梭状回的负性功能连接强度均低于健康对照组(-0.10±0.26比-0.30±0.19、0.02±0.18比-0.23±0.17、0.08±0.26比-0.17±0.25、-0.04±0.25比-0.27±0.17、-0.08±0.25比-0.31±0.21、-0.01±0.25比-0.18±0.17,t =3.71、5.20、4.06、4.27、3.80、3.57,均P＜0.05,校正后).结论 ADHD儿童默认网络内部连接存在异常,默认网络与任务激活网络之间的负性连接强度降低；推测默认网络内部活动同步性降低、默认网络与前额-顶叶注意网络之间的平衡关系受损可能是ADHD的重要神经机制.
목적 통과주의결함다동장애(ADHD)인동정식태공능자공진성상(fMRI)후구대회공능련접적변화종뇌구간련접적각도탐토ADHD적신경궤제.방법 선택2008년6월지2010년4월우소주대학부속제삼의원인동다동증문진취진적혼합형ADHD인동30례급동기상주시일소보통소학년령、성별상필배적건강대조조30명,진행정식태fMRI소묘,사용REST연건이후구대회위감흥취구여전뇌기타구역진행공능련접분석병비교조간차이.결과 ADHD조여건강대조조내여후구대회유현저공능련접적뇌구기본일치,정성련접적뇌구주요위우묵인망락,부성련접적뇌구주요위우배외측전액협、배측전구대회、정하소협、기저절구역(균P＜O.05,교정후).ADHD조후구대회여쌍측내측전액협、우측후구대회、우측섭하회、소뇌후협적정성공능련접강도균저우건강대조조(0.07±0.20비0.33±0.23、0.25±0.28비0.48±0.30、-0.05±0.19비0.22±0.22、-0.04±0.21비0.17±0.16,t=-5.47、-3.44、-4.61、-3.99,균P＜0.05,교정후)；후구대회여좌측도협、우측정하소협、좌측중앙후회、좌측섭상회、우측섭상회、좌측사상회적부성공능련접강도균저우건강대조조(-0.10±0.26비-0.30±0.19、0.02±0.18비-0.23±0.17、0.08±0.26비-0.17±0.25、-0.04±0.25비-0.27±0.17、-0.08±0.25비-0.31±0.21、-0.01±0.25비-0.18±0.17,t =3.71、5.20、4.06、4.27、3.80、3.57,균P＜0.05,교정후).결론 ADHD인동묵인망락내부련접존재이상,묵인망락여임무격활망락지간적부성련접강도강저；추측묵인망락내부활동동보성강저、묵인망락여전액-정협주의망락지간적평형관계수손가능시ADHD적중요신경궤제.
Objective To explore the pathophysiological changes in the functional connectivity of posterior cingulate cortex (PCC) with other brain regions in children with attention-deficit or hyperactivity disorder (ADHD) on resting-state functional magnetic resonance imaging (fMRI) and explore the neural mechanisms of ADHD at the point of relationships between brain regions.Methods Thirty children with ADHD from the Third Affiliated Hospital of Soochow University from June 2008 to April 2010 and another 30 age-and-gender-matched controls from a normal primary school over the same period underwent resting-state fMRI scans.And blood oxygenation level dependent (BOLD) signal was acquired to calculate the functional connectivity of PCC with other brain regions controls.Singnificant differences of connectivity between groups were analyzed with REST software.Results The pattern of functional connectivity of PCC for the ADHD group was similar to that of the control group.Significant positive functional connectivity with PCC was observed in the default mode of network (DMN) while negative functional connectivity was present in dorlateral prefrontal cortex,anterior cingulate,parietal cotex and basal ganglia (all P ＜ 0.05,corrected).Compared to the controls,the ADHD group exhibited decreased positive connectivity with PCC in bilateral medial prefrontal cortex (0.07 ±0.20 vs 0.33 ±0.23,t =-5.47),right posterior cingulate gyrus(0.25 ±0.28 vs 0.48 ± 0.30,t =-3.44),right inferior temporal gyrus (-0.05 ± 0.19 vs 0.22 ± 0.22,t =-4.61) and cerebellar posterior lobe (-0.04 ± 0.21 vs 0.17 ± 0.16,t =-3.99),while decreased negative functional connectivity with PCC was observed in left insula (-0.l0 ± 0.26 vs-0.30 ± 0.19,t =3.71),right inferior parietal lobule (0.02 ± 0.18 vs-0.23 ± 0.17,t =5.20),left postcentral gyrus (0.08±0.26 vs-0.17±0.25,t=4.06),left superior temporal gyrus (-0.04±0.25 vs-0.27 ±0.17,t=4.27),right superior temporal gyrus (-0.08 ±0.25 vs-0.31 ±0.21,t =3.80) and left fusiform gyrus (-0.01 ±0.25 vs-0.18 ±0.17,t =3.57) (all P ＜0.05,corrected).Conclusions The connectivity of DMN between brain regions is abnormal in ADHD group.And the strengthen of negative relationship between DMN and task activated network becomes reduced.It is surmised that the decreased internal synchronization of default network and disrupted balance between DMN and prefrontal-parietal attentional networks may be important neural mechanisms of ADHD.