TIPS术后脑默认网络的静息态功能磁共振成像研究  

Study of default mode network alteration of brain with resting state fMRI in cirrhotic patients after transjugular intrahepatic portosystemic shunt

作　　者：梁雪[1,2,3] 张龙江[1,2] 倪玲 罗松[1,2,3] 孔祥 戚荣丰[1,2] 许强[1,2] 钟元 卢光明[1,2] 

机构地区：[1]南京军区南京总医院医学影像科 [2]南京大学医学院附属金陵医院影像科,210002 [3]徐州医学院影像学院,221004

出　　处：《放射学实践》2014年第1期31-35,共5页Radiologic Practice

基　　金：国家自然科学基金项目资助(81230032;81322020)

摘　　要：目的:运用静息态功能磁共振成像(rs-fMRI)研究经颈静脉肝内门体分流术(TIPS)对肝硬化患者脑默认网络(DMN)的影响。方法:10例拟行TIPS治疗的肝硬化患者(患者组)和10例正常对照者(对照组)纳入本研究。10例正常对照者及10例患者术前、术后(平均8天)均行rs-fMRI。利用独立成分分析方法分离得到各受试者的默认网络脑区,采用单样本t检验对患者术前和对照组进行组内分析,观察各自的DMN空间分布模式;分别对患者TIPS术前与正常对照组、患者TIPS术后与术前的DMN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。结果:TIPS术前肝硬化患者和正常对照组均显示出典型的静息态脑默认网络空间分布模式。与正常对照组相比,TIPS术前肝硬化患者默认网络脑区功能连接既有降低也有增高,降低脑区包括左侧额中回背外侧、双侧顶下小叶及颞叶;增高的脑区主要位于双侧后扣带回、楔前叶及内侧前额叶。与TIPS术前相比,患者术后出现双侧楔前叶及角回功能连接增强,而后扣带回及内侧前额叶功能连接度减低。结论:静息状态下,TIPS术后早期肝硬化患者脑默认网络功能连接即出现改变,既有功能连接减低也有增强,提示TIPS对肝硬化患者脑默认网络既有功能损伤又有代偿机制。Objective：To investigate the default mode network （DMN） alteration of brain in cirrhosis patients after transjugular intrahepatic portosystemic shunt （TIPS） using resting-state functional MRI （rs-fMRI）. Methods：Ten cirrhotic patients （cirrhosis group） who were scheduled for TIPS and 10 healthy controls （control group） were recruited in this stud- y. All had rs-fMRI studies before and after （median： 8d） TIPS. The fMRI data were processed based on MATLAB and GIFT. Group spatial independent component analysis （ICA） was performed to extract the DMN. Single sample t tests were performed for cirrhosis group before TIPS and healthy control group; as well as cirrhosis group after and before TIPS to study the inter-group DMN functional connectivity patterns of brain with rs-fMRI. Results;Typical spatial distributions of the DMN were found in both cirrhotic patients before TIPS and control group. Compared with the control group,there were reduction and increase of functional connectivity of DMN in brain. The brain areas with reduced functional connectivity in- cluded dorsal medial area of left frontal gyrus, bilateral inferior parietal lobule and temporal lobe. The brain areas with in- creased functional connectivity were mainly located in bilateral posterior cingulate gyri, precuneus and ventral medial areas of anterior frontal lobe. Compared with cirrhosis group before TIPS, functional connectivity increased in bilateral precuneus and angular gyrus,while reduced in bilateral posterior cingulate gyrus and ventral medial areas of anterior frontal lobe after TIPS. Conclusion=In the resting state,alteration of cirrhotic patientg DMN patterns could appear in patients with early cir- rhosis which could be reduction and increase of functional connectivity, suggesting that both impairment and compensatory mechanism of DMN functional connectivity could be assessed in patients after TIPS.

关 键 词：经颈静脉肝内门体分流术 脑默认网络 磁共振成像 

分 类 号：R575.2[医药卫生—消化系统] R445.2[医药卫生—内科学]