轻微肝性脑病患者默认模式网络功能连接研究  

Study of Default Mode Network Functional Connectivity Changes in Patients with Minimal Hepatic Encephalopathy using Resting-stat Functional MRI

作　　者：杨旭[1] 赵建农[1] YANG Xu;ZHAO Jian-nong(Department of Imaging,Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院影像科,重庆400010

出　　处：《中国CT和MRI杂志》2018年第9期54-56,72,共4页Chinese Journal of CT and MRI

摘　　要：目的采用静息态功能磁共振成像(rs-fMRI)研究轻微肝性脑病患者默认网络(DMN)脑区功能连接的改变情况。方法本研究共纳入73例肝硬化患者和73名匹配的健康对照者进行rs-fMRI扫描,采用DPARSF软件分析得到DMN相关脑区功能连接的变化情况,并使用方差分析比较各组之间差异;使用皮尔森相关分析DMN中脑区功能连接改变和神经心理功能测试结果之间的联系,ROC分析评估可靠性。结果与HC组相比,肝硬化患者DMN中额前内侧回(MPFC),后扣带回/楔前叶(PCC/PCUN),左侧颞极(TP)以及双侧海马旁回(PHG)DMN连接下降,而与non-HE患者相比,MHE组患者在MPFC,PCC/PCUN,以及右侧PHG脑区间的功能连接降低。其中MPFC出现改变的有效性最高(敏感度81.5%,特异度70.4%)。结论肝硬化患者从non-HE发展为MHE的过程中,DMN部分脑区的功能连接减低,这为轻微肝性脑病的诊断提供了一种新的思路。Objective To investigate the contribution of brain default mode net-work （DMN） in the early diagnosis of the minimal hepatic encephalopathy （MHE）, the mildest form of HE from cirrhotic patients by using resting-state functional magnetic resonance imaging （rs-fMRI）. Methods A total of 73 cirrhotic patients and 73 matched healthy controls underwent rs-fMRI scanning. The DMN correlation map was acquired by using unbiased seed-based functional connectivity analysis and compared among MHE patients, non-HE patients, and healthy controls with analysis of variance tests. Pearson correlation analysis was performed between the abnormal DMN connectivity and neuropsychological performances. Receiver operator characteristic （ROC） analysis was used to evaluate the contribution of DMN connectivity strength in the differential diagnosis between MHE and non-HE. Results Compared with the healthy controls, MHE and non-HE patients showed decreased DMN connectivity in medial prefrontal cortex （MPFC）, posterior cingulated cortex/precuneus （PCC/PCUN）, left temporal pobe, and bilateral parahippocampal gyrus （PHG）. The MHE patients showed even more decreased connectivity in MPFC, PCC/PCUN, and right PHG when compared with non-HE patients. Pearson correlation analyses revealed that the decreased connectivity strength of some DMN regions correlated with patients＇ neuropsychological tests scores. The MPFC had the highesteffectiveness （sensitivity 1/4 81.5%, specificity 1/4 70.4%）. Conclusion Cirrhotic patients had gradually reduced DMN functional connectivty from non-HE patients to MHE patients. DMN function, especially the MPFC, might be a useful imaging marker for differentiating MHE from cirrhotic patients.

关 键 词：轻度肝性脑病 默认模式网络功能连接 静态功能磁共振成像 

分 类 号：R651.1[医药卫生—外科学]