左侧颞叶癫痫患者脑白质纤维结构完整性与执行功能研究  

White matter fiber structural integrity in diffusion tensor imaging and executive function of patients with left temporal lobe epilepsy

作　　者：王后芬 黄书蕾 黄明明 余晖 杨丽铭 冯占辉 于云莉 WANG Houfen;HUANG Shulei;HUANG Mingming;YU Hui;YANG Limin;FENG Zhanhui;YU Yunli(Department of Neurology,Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou Province,550004,China;Department of Imaging,Affiliated Hospital of Guizhou Medical University,Guiyang,Guizhou Province,550004,China)

机构地区：[1]贵州医科大学附属医院神经内科,贵阳550004 [2]贵州医科大学附属医院影像科,贵阳550004

出　　处：《第三军医大学学报》2020年第14期1414-1420,共7页Journal of Third Military Medical University

基　　金：贵州省科技计划项目(黔科合LH字〔2016〕7238号)。

摘　　要：目的探讨常规MRI阴性的左侧颞叶癫痫(left temporal lobe epilepsy,L-TLE)患者执行功能损害特点及其与脑白质纤维束微观结构完整性的关系。方法对2018年11月至2019年11月就诊本院的21例L-TLE患者和21例健康对照(healthy control group,HC)进行执行功能评估,包括词语流畅性试验、Stroop色词干扰试验A^C(Stroop color word interference test A^C,Stroop test,A^C)、连线试验、数字广度测试,并对以上患者及对照组进行弥散张量成像(diffusion tensor imaging,DTI)扫描,比较两者纤维束部分各向异性(fractional anisotropy,FA)值、平均弥散率(mean diffusivity,MD)值,将微观结构有变化的纤维束与执行功能评分行相关性分析。结果L-TLE患者在数字广度顺向分数(P=0.028)、词语流畅性分数(P<0.001)较对照组低,StroopC耗时(P=0.008)较对照组高。与对照组相比,L-TLE患者左侧丘脑前辐射、左侧扣带束海马部、胼胝体枕部FA值降低,左侧丘脑前辐射、双侧扣带束、左侧扣带束海马部、胼胝体额部、双侧钩束MD值升高,差异有统计学意义(P<0.05)。相关分析显示:StroopC与左侧丘脑前辐射FA值(r=-0.461,P=0.035)呈负相关,与左侧丘脑前辐射MD值(r=0.634,P=0.002)呈正相关;词语流畅性与左侧扣带束海马部FA值(r=0.486,P=0.026)呈正相关,与左侧钩束MD值(r=-0.513,P=0.017)呈负相关;连线B与左侧丘脑前辐射MD值(r=0.481,P=0.043)呈正相关。结论MRI阴性的L-TLE患者存在执行功能障碍,并出现脑白质纤维束尤其是额颞叶间纤维束完整性的改变;TLE患者执行功障碍与额颞叶纤维束改变有关;额颞叶纤维结构连接异常可能为导致MRI阴性的TLE患者执行功能障碍原因之一。Objective To investigate the characteristics of executive dysfunction and its association with microstructural integrity of white matter fiber bundle in patients with left temporal lobe epilepsy(L-TLE)who have negative findings in conventional magnetic resonance imaging(MRI).Methods Executive function assessments,including Verbal fluency Test,Stroop Color Word Interference Test A^C(Stroop test,A^C),Trail Marking Test and Digit Span Test,were performed in 21 patients with L-TLE and 21 healthy control subjects.The patients and the control subjects underwent scanning with diffusion tensor imaging(DTI)to compare their fiber bundle fractional anisotropy(FA)and the mean diffusivity(MD)values.The correlation between the fiber bundles with microstructural alterations and the executive function score was analyzed.Results Compared with the control subjects,the patients with L-TLE had significantly lower scores for digit span forward(P=0.028)and verbal fluency(P<0.001),and spent more time in Stroop C test(P=0.008).The patients with L-TLE showed significantly decreased FA values in the left anterior thalamic radiation,the left cingulate gyrus near the hippocampus and the forceps major,and increased MD values in the left anterior thalamic radiation,the bilateral cingulate gyrus,the left cingulate gyrus near the hippocampus,the forceps minor and the bilateral uncinate fasciculus compared with the control subjects.Correlation analysis showed that Stroop C test score was negatively correlated with the FA value in the left anterior thalamic radiation(r=-0.461,P=0.035)and positively with the MD value in the left anterior thalamic radiation(r=0.634,P=0.002);Verbal fluency was positively correlated with the FA value in the left-sided cingulate gyrus near the hippocampus(r=0.486,P=0.026)and negatively with the MD value in the left uncinate fasciculus(r=-0.513,P=0.017);Trail Marking Test B score was positively correlated with the MD value in the left anterior thalamus radiation(r=0.481,P=0.043).Conclusion The MRI-negative patients wit

关 键 词：颞叶癫痫 执行功能 纤维连接损害 弥散张量成像 脑白质 纤维结构 

分 类 号：R445.2[医药卫生—影像医学与核医学] R741.02[医药卫生—诊断学]