肌萎缩侧索硬化患者认知功能障碍的静息态功能磁共振成像分析  

Resting-state functional MRI studies of amyotrophic lateral sclerosis patients with various levels ofcognitive impairment

作　　者：沈东超[1] 侯波[2] 崔博[1] 李晓璐[1] 彭攀[1] 邰宏飞[1] 张亢 刘双武 付瀚辉 刘明生[1] 冯逢[2] 崔丽英[1] Shen Dongchao;Hou Bo;Cui Bo;Li Xiaolu;Peng Pan;Tai Hongfei;Zhang Kang;Liu Shaangwu;Fu Hanhui;Liu Mingsheng;Feng Feng;Cui Liying(Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences ,Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经科,100730 [2]中国医学科学院北京协和医学院北京协和医院放射科,100730

出　　处：《中华医学杂志》2018年第25期2002-2006,共5页National Medical Journal of China

摘　　要：目的比较不同认知水平的肌萎缩侧索硬化（ALS）患者的静息态功能磁共振（Rs-fMRI）数据，探索其脑功能改变。方法2013年9月至2017年3月于北京协和医院神经科门诊及病房诊断的55例ALS患者及20名健康对照者（Hc）被纳入研究，所有受试者均进行成套的神经心理学测验及RS-fMRI扫描。按照其认知功能，ALS患者被进一步分为三个亚组：27例无认知功能障碍的ALS（ALS-Cn）、17例ALS伴认知损害（ALS-Ci）及11例ALS合并额颞叶痴呆（ALS-FTD）。应用分数低频振幅（fALFF）法和局部一致性（ReHo）法，比较不同亚组间的静息激活差异。结果四组受试者的fALFF值在双侧额上回、额中回、左侧颞中回、左侧扣带回存在差异（P〈0．001，未校正），ReHo值在左侧额上回、额下回、右侧颞中回、左侧扣带回存在差异（P〈0．05，FDR校正），对灰质体积进行校正后上述差异减小。差异来源主要为ALS-FTD较其他三组受试者在上述区域存在fALFF值及ReHo减低，且与健康对照的差异最为显著，主要位于左侧前额叶及前扣带回。ALS-Ci与ALS-Cn，ALS-Ci与健康对照，ALS-Cn与健康对照相比较，在设定阈值下（P〈0．001，未校正）未发现全脑RS-fMRI数据存在显著差异。结论ALS-FTD患者存在运动区外的激活减低，RS-fMRI有助于探索ALS认知功能障碍发生发展的病理生理机制。Objective To characterize the brain functional changes of amyotrophic lateral sclerosis （ALS） patients with various levels of cognitive impairment as measured by resting-state functional MR1 （ RS- fMRI）. Methods From September 2013 to March 2017, a total of 55 patients diagnosed with ALS in Peking Union Medical College Hospital and 20 healthy controls （HCs） were included in this study, and all participants underwent neuropsychological assessments and diffusion tensor imaging scans. According to their cognitive performance, ALS patients were further subclassified into ALS with normal cognition （ ALS-Cn, n = 27 ） ,those with cognitive impairment （ ALS-Ci, n = 17 ） and ALS-FTD （ n = 11 ）. Comparisons of fractional amplitude of low frequency fluctuation （fALFF） value and regional homogeneity （ReHo） value were conducted among the 4 subgroups. Results The fALFF showed significant differences in bilateral frontal lobe, left temporal lobe and cingulate gyms, （P〈0. 001, uncorrected） and the ReHo showed significant differences in left frontal lobe, right temporal lobe and left eingulate gyms （P 〈 0. 001, FDR corrected）. The differences mainly stemmed from that patients with ALS-FTD showed decreased fALFF and ReHo in these areas when compared to the other three groups, especially in relation to HCs, mainly locating in leftprefrontal lobe and anterior cingulate cortex. The whole-brain comparisons of fALFF and ReHo between ALS- Ci, ALS-Cn and HCs revealed no significant difference （P〈 0. 001, uncorrected ）. Conclusion Hypoactivities are detected in extramotor areas in patients with ALS-FTD. RS-fMRI is helpful in investigating the pathophysiologic mechanism of cognitive impairment in ALS.

关 键 词：肌萎缩侧索硬化 认知障碍 额颞叶退化 痴呆 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R744.8[医药卫生—诊断学]