CAJ | 학술논문

目的探讨弥漫性轴索损伤意识障碍患者的大脑默认网络(DMN)早期功能连接异常及其对伤后意识水平的评估作用.方法选取2013年4月至2014年3月广州军区武汉总医院神经外科收治的15例临床诊断为弥漫性轴索损伤的意识障碍患者.采集15例弥漫性轴索损伤的意识障碍患者和15例健康志愿者的静息态功能磁共振数据,应用独立成分分析方法,提取每例受试者的DMN成分,组间行双样本t检验得出差异性脑区,并将差异性脑区与患者采集磁共振数据当日的格拉斯哥昏迷评分(GCS)、伤后6个月的昏迷恢复量表评分(CRS-R)进行相关性分析.结果弥漫性轴索损伤患者脑DMN内楔前叶/后扣带回、双侧顶下小叶、前额腹内侧皮质和左侧颞叶的功能连接度显著低于健康对照组(P＜0.01),楔前叶/后扣带回的功能连接与GCS评分及CRS-R评分均呈显著性幂相关(P＜0.05,P＜0.01).结论弥漫性轴索损伤意识障碍患者的早期大脑DMN功能连接出现异常,楔前叶/后扣带回的功能连接异常可成为评估意识障碍程度及意识障碍预后的一个指标.
목적 탐토미만성축색손상의식장애환자적대뇌묵인망락(DMN)조기공능련접이상급기대상후의식수평적평고작용.방법 선취2013년4월지2014년3월엄주군구무한총의원신경외과수치적15례림상진단위미만성축색손상적의식장애환자.채집15례미만성축색손상적의식장애환자화15례건강지원자적정식태공능자공진수거,응용독립성분분석방법,제취매례수시자적DMN성분,조간행쌍양본t검험득출차이성뇌구,병장차이성뇌구여환자채집자공진수거당일적격랍사가혼미평분(GCS)、상후6개월적혼미회복량표평분(CRS-R)진행상관성분석.결과 미만성축색손상환자뇌DMN내설전협/후구대회、쌍측정하소협、전액복내측피질화좌측섭협적공능련접도현저저우건강대조조(P＜0.01),설전협/후구대회적공능련접여GCS평분급CRS-R평분균정현저성멱상관(P＜0.05,P＜0.01).결론 미만성축색손상의식장애환자적조기대뇌DMN공능련접출현이상,설전협/후구대회적공능련접이상가성위평고의식장애정도급의식장애예후적일개지표.
Objective To investigate the early abnormal functional connectivity of brain default mode network (DMN) and its evaluation for consciousness level after injury in consciousness disorder patients with diffuse axonal injury.Methods A total of 15 patients with consciousness disorder diagnosed as diffuse axonal injury at Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command from April 2013 to March 2014 were selected.The resting-state functional magnetic resonance data of the 15 consciousness disorder patients with diffuse axonal injury and 15 healthy volunteers were collected.The independent component analysis was used to extract the DMN ingredient in each subject.The two-sample t-test was performed between the groups in order to obtain the different brain areas, and the correlation analysis of the Glasgow coma scale (GCS) and the coma recovery scale-revised (CRS-R) at 6 months after injury were performed at the different brain areas and the magnetic resonance data were collected on the same day.Results The functional connectivity degree of the precuneus/posterior cingulate, bilateral inferior parietal lobule, ventromedial prefrontal cortex, and left temporal lobe in brain DMN in patients with diffuse axonal injury were significantly lower than those of control group (P ＜ 0.01).The functional connectivity of the precuneus/posterior cingulated and GCS showed significant power correlation (P ＜ 0.05), and it also showed significant power correlation with CRS-R (P ＜ 0.01).Conclusions The early brain DMN functional connectivity has abnormality in consciousness disorder patients with diffuse axonal injury.The abnormal functional connectivity of the precuneus/posterior cingulate may become an indicator for assessing the degree of consciousness disorder and the prognosis of consciousness disorder.