CAJ | 학술논문

目的：探讨儿童失神癫痫（ CAE）患者的默认网络（ DMN）及与临床特点的关系。方法于2012年9月至2014年6月在河南省人民医院招募14例CAE患儿与14名健康志愿者（对照组），以双侧楔前叶／后扣带回为种子点，应用静息态fMRI 功能连接（ FC ）方法，依次分析健康对照组DMN、CAE患者组DMN、两组间DMN的差别以及FC强度与临床特点的相关性。结果健康对照组双侧角回、双侧顶上回、双侧额上回额中回、双内侧额上回、双侧颞中回、双侧枕上回枕中回与双侧楔前叶／后扣带回均存在正性连接；CAE患者双侧顶上回、双侧枕上回与双侧楔前叶／后扣带回存在正性连接。两组间DMN比较显示，CAE患者双内侧眶额部[坐标值（ x， y， z）：3，60，－9，t＝－5．24，P＜0．01]、左侧额上回／额中回[坐标值（x， y， z）：－24，24，48，t＝－5．21，P＜0．01]、右侧额上回／额中回[坐标值（x， y， z）：18，30，45，t＝－4．14，P＜0．01]、左侧前扣带回／尾状核[坐标值（x， y， z）：－3，15，－6，t＝－7．59，P＜0．01]及右侧前扣带回[坐标值（x， y， z）：9，48，15，t＝－7．59，P＜0．01]与双侧楔前叶／后扣带回FC降低；右侧旁中央小叶／扣带回中部[坐标值（ x， y， z）：12，－36，54，t＝6．19，P＜0．01]与双侧楔前叶／后扣带回FC增加。双内侧眶额部及双侧额上回／额中回与双侧楔前叶／后扣带回FC强度与病程呈负相关（r＝－0．544，－0．534，－0．790，P＜0．05），与发作频率、发病年龄无相关性。结论 CAE患者静息态脑默认网络受损，推测是引起发作期意识障碍和认知障碍的神经基础，且异常的DMN可能是失神癫痫疾病进展的生物学标志。
목적：탐토인동실신전간（ CAE）환자적묵인망락（ DMN）급여림상특점적관계。방법우2012년9월지2014년6월재하남성인민의원초모14례CAE환인여14명건강지원자（대조조），이쌍측설전협／후구대회위충자점，응용정식태fMRI 공능련접（ FC ）방법，의차분석건강대조조DMN、CAE환자조DMN、량조간DMN적차별이급FC강도여림상특점적상관성。결과건강대조조쌍측각회、쌍측정상회、쌍측액상회액중회、쌍내측액상회、쌍측섭중회、쌍측침상회침중회여쌍측설전협／후구대회균존재정성련접；CAE환자쌍측정상회、쌍측침상회여쌍측설전협／후구대회존재정성련접。량조간DMN비교현시，CAE환자쌍내측광액부[좌표치（ x， y， z）：3，60，－9，t＝－5．24，P＜0．01]、좌측액상회／액중회[좌표치（x， y， z）：－24，24，48，t＝－5．21，P＜0．01]、우측액상회／액중회[좌표치（x， y， z）：18，30，45，t＝－4．14，P＜0．01]、좌측전구대회／미상핵[좌표치（x， y， z）：－3，15，－6，t＝－7．59，P＜0．01]급우측전구대회[좌표치（x， y， z）：9，48，15，t＝－7．59，P＜0．01]여쌍측설전협／후구대회FC강저；우측방중앙소협／구대회중부[좌표치（ x， y， z）：12，－36，54，t＝6．19，P＜0．01]여쌍측설전협／후구대회FC증가。쌍내측광액부급쌍측액상회／액중회여쌍측설전협／후구대회FC강도여병정정부상관（r＝－0．544，－0．534，－0．790，P＜0．05），여발작빈솔、발병년령무상관성。결론 CAE환자정식태뇌묵인망락수손，추측시인기발작기의식장애화인지장애적신경기출，차이상적DMN가능시실신전간질병진전적생물학표지。
Objective To explore the default mode network ( DMN) in childhood absence epilepsy ( CAE ) patients and examine their correlations between functional connectivity ( FC ) and clinical characteristics.Methods Fourteen CAE patients and 14 healthy volunteers were prospectively recruited from Henan Provincial People′s Hospital from September 2012 to June 2014.FC in DMN of each group, between-group comparison of DMN FC and their relationships with clinical characteristics were respectively analyzed with 3.0T resting-state functional magnetic resonance imaging ( fMRI) FC analysis seeding at bilateral precuneus/posterior cingulate cortex ( PCC ) .Results Seeding at bilateral precuneus/posterior cingulate cortex ( PCC) , positive connection was found in bilateral angular gyrus, bilateral superior parietal gyrus, bilateral superior and middle frontal gyrus, bilateral superior medial frontal gyrus, bilateral middle temporal gyrus and bilateral superior and middle occipital gyrus in controls.However, positive connection in CAE patients was observed in bilateral superior parietal gyrus and bilateral superior occipital gyrus.Between-group analysis of DMN connectivity revealed a reduction of DMN FC in bilateral medial orbitofrontal cortex, <br> bilateral anterior cingulate cortex, bilateral superior frontal gyrus, bilateral middle frontal gyrus and left caudate in CAE patients.Moreover, increased DMN FC was present in right paracentral lobule and right middle cingulate gyrus.FC between PCC and bilateral medial orbitofrontal cortex or bilateral superior/middle frontal gyrus correlated negatively with disease duration, but there was no correlation with seizure frequency or initial age.Conclusion Brain′s default mode network in childhood absence epilepsy is impaired, presumably, as a result of unconsciousness and cognitive impairment during absence seizure.Abnormal DMN activities may be a biomaker of disease progress in absence epilepsy.