CAJ | 학술논문

目的：运用静息态功能磁共振成像（rs‐fMRI）研究皮质下缺血性血管性认知功能障碍（VCI‐SIVD）患者在静息状态下的脑默认网络（DM N）。方法收集缺血性脑小血管疾病患者68例，经临床痴呆量表评分后分为血管性痴呆组（V aD 组）12例，非痴呆型血管性认知功能障碍组（VCIND 组）21例，认知功能正常者35例为对照组，分别采集高分辨率结构像和静息态功能磁共振数据，通过独立成分分析方法（ICA）计算并对比3组患者脑功能活动的改变。采用两样本 t检验分别对 VCIND 组与正常对照组、V aD 组与 VCIND 组、V aD 组与正常对照组 DM N 的功能连接进行组间比较，观察静息状态下脑默认网络的改变情况，并分析 V aD 患者 DM N 默认网络与认知功能间的相关性。结果与正常对照组相比，VCIND 组患者默认网络脑区的功能连接既有增高也有降低，增高的脑区包括双侧顶叶及颞中回，降低的脑区包括眶额叶、内侧前额叶、前扣带回及双侧枕叶；V aD 组患者出现双侧小脑的功能连接增强，V aD 组眶额叶、额中回、额下回、双侧枕叶及双侧颞叶的功能连接减低；V aD 患者 DM N 统计脑图与数字连线 A 、数字符号转换、MOCA 等多个临床量表评分存在显著相关性，差异有统计学意义（ P ＜0．05）。结论在静息状态下，血管性认知功能障碍患者的大脑默认模式网络存在异常，并存在以执行功能障碍为主的多个领域的认知功能损害，其认知功能障碍可能与额叶‐皮质下环路受损有关。独立成分分析在评价血管性认知功能障碍及其早期诊断中有重要价值。
목적：운용정식태공능자공진성상（rs‐fMRI）연구피질하결혈성혈관성인지공능장애（VCI‐SIVD）환자재정식상태하적뇌묵인망락（DM N）。방법수집결혈성뇌소혈관질병환자68례，경림상치태량표평분후분위혈관성치태조（V aD 조）12례，비치태형혈관성인지공능장애조（VCIND 조）21례，인지공능정상자35례위대조조，분별채집고분변솔결구상화정식태공능자공진수거，통과독립성분분석방법（ICA）계산병대비3조환자뇌공능활동적개변。채용량양본 t검험분별대 VCIND 조여정상대조조、V aD 조여 VCIND 조、V aD 조여정상대조조 DM N 적공능련접진행조간비교，관찰정식상태하뇌묵인망락적개변정황，병분석 V aD 환자 DM N 묵인망락여인지공능간적상관성。결과여정상대조조상비，VCIND 조환자묵인망락뇌구적공능련접기유증고야유강저，증고적뇌구포괄쌍측정협급섭중회，강저적뇌구포괄광액협、내측전액협、전구대회급쌍측침협；V aD 조환자출현쌍측소뇌적공능련접증강，V aD 조광액협、액중회、액하회、쌍측침협급쌍측섭협적공능련접감저；V aD 환자 DM N 통계뇌도여수자련선 A 、수자부호전환、MOCA 등다개림상량표평분존재현저상관성，차이유통계학의의（ P ＜0．05）。결론재정식상태하，혈관성인지공능장애환자적대뇌묵인모식망락존재이상，병존재이집행공능장애위주적다개영역적인지공능손해，기인지공능장애가능여액협‐피질하배로수손유관。독립성분분석재평개혈관성인지공능장애급기조기진단중유중요개치。
Objective To explore the default mode network (DMN) of patients with subcortical ischemic vascular cogni‐tive dementia (SIVD) ,a subtype of vascular cognitive impairment (VCI) ,under the resting state ,by the means of resting state functional magnetic resonance imaging (rs‐fMRI) .Methods 68 patients with cerebral small vessel disease ,who were matched on age ,gender ,and education level after evaluation with the clinical dementia criterion ,were collected in this work .Of those 60 patients ,12 were vascular dementia (VaD) ,21 were vascular cognitive impairment‐no dementia (VCIND) ,and 35 were normal cognitive function that was classified as a control group .The high resolution structure im‐age and resting‐state fMRI data were acquired .The changes in brain activity of patients in three groups were calculated and compared through the independent component analysis (ICA) method .The situation of changes in brain default networks under resting state between the two groups was observed using two‐sample t‐test ,respectively .Also ,the correlation be‐tween the DMN and cognitive function in patients with VaD was analyzed .Results Compared with normal control group , the default function of the network connection in VCIND patients exhibited both higher and lower brain areas ,i .e .,the higher brain regions included the bilateral parietal and temporal gyrus ,while ,the lower brain regions included the orbito‐frontal cortex ,medial prefrontal cortex ,anterior cingulate cortex ,and bilateral occipital lobe .In VaD patients ,the bilat‐eral cerebellar functional connectivity was enhanced ,whereas ,the functional connection in orbital frontal ,frontal gyrus , inferior frontal gyrus ,bilateral occipital and bilateral temporal lobe was reduced .DMN of VaD group had a significant cor‐relation with Digital connection A ,digit symbol conversion and MOCA scale score ,with statistically significant difference ( P < 0 .05) .Conclusion Under the resting state ,the DMN in patients with SIVD exists abnormity .The cognitive im‐pairment in multiple dominating fields for executive dysfunction was also exists in SIVD patients .The cognitive dysfunction may be associated with frontal - subcortical loop impairment .ICA dysfunction and early diagnosis have an important value in the evaluation of vascular cognition .