弥漫性轴索损伤意识障碍患者的脑默认网络研究  

Brain default mode network study of consciousness disorder patients with diffuse axonal injury

作　　者：姚顺[1] 宋健[1] 黄河[1] 高利臣[1] 闫研[1] 杜浩[1] 徐国政[1] 

机构地区：[1]广州军区武汉总医院神经外科,430070

出　　处：《中华神经外科杂志》2015年第11期1135-1140,共6页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金（81400865）;全军医学科技“十二五”重点项目（BWS11J066）

摘　　要：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，组问行双样本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。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 cingnlate may become an indicator for assessing the degree of consciousness disorder and the prognosis of consciousness disorder.

关 键 词：弥漫性轴索损伤 意识障碍 预后 磁共振成像 默认网络 

分 类 号：R651.15[医药卫生—外科学]