抗N-甲基-D-天冬氨酸受体脑炎患者脑血流的特征  

Altered cerebral blood flow in patients with anti-NMDAR encephalitis

作　　者：李成林[1] 侍永伟 葛剑青[1] 余传勇[1] 吴迪[1] 郁媛文 易青 苗爱亮 Li Chengling;Shi Yongwei;Ge Jianqing;Yu Chuanyong;Wu Di;Yu Yuanwen;Yi Qing;Miao Ailiang(Department of Neurology,the Affiliated Brian Hospital of Nanjing Medical University,Jiangsu 210019,China)

机构地区：[1]南京医科大学附属脑科医院,江苏210029 [2]泰州市第四人民医院 [3]滁州市来安家宁医院

出　　处：《脑与神经疾病杂志》2021年第9期538-543,共6页Journal of Brain and Nervous Diseases

基　　金：国家自然科学基金青年项目(81501126);江苏省青年医学重点人才(QNRC2016053);南京医科大学附属脑科医院青年人才项目。

摘　　要：目的研究抗N-甲基-D-天冬氨酸受体(anti-N-methyl-d-aspartate receptor,NMDAR)脑炎患者的脑血流(cerebral blood flow,CBF)改变的方式。方法本研究纳入23例抗NMDAR脑炎患者和32例年龄及性别匹配的正常对照。将利用动脉自旋标记成像技术研究抗NMDAR脑炎患者急性期和正常对照的静息态CBF在哪些脑区存在差异。然后,比较抗NMDAR脑炎患者和正常对照存在CBF差异脑区的CBF连接是否也存在差异。结果本文显示,和正常人相比,抗NMDAR脑炎患者双侧楔前叶、双侧枕叶CBF降低(P<0.05,FEW校正)。相反,与正常人相比,抗NMDAR脑炎患者左侧(left,L)颞上回、L-海马、L-岛叶、L-苍白球、双侧(Bilateral,Bi)壳核、Bi-尾状核CBF增高(P<0.05,FEW校正)。发现与正常人相比,抗NMDAR脑炎患者Bi-楔前叶、枕叶与L-颞叶、岛叶之间CBF链接减少(P<0.05,FEW校正)。结论表明抗NMDAR脑炎患者脑内不仅存在局部CBF的异常,还存在CBF连接的改变,这些改变可能是抗NMDAR脑炎患者的临床症状的神经机制。Objective This study aimed to identify to resting-state cerebral blood flow(CBF)and connectivity alterations in patients with anti-N-methyl-d-aspartate receptor(anti-NMDAR)encephalitis.Methods In additon to the resting-state CBF differences,arterial spin labeling(ASL)imaging was also used to analyze the alterations in CBF connectivity in brain regions of interest between 23 patients with anti-NMDAR encephalitis at the peak stage of the disease and 32 healthy subjects.Results By contrast to the healthy subjects,the patients with anti-NMDAR encephalitis displayed increased CBF in the left superior temporal lobe(LSTL),left insula(Linsula),Lhippocampus,Lpallidum,bilateral putamen(Biputamen),and Bicaudate and decreased CBF in the bilateral precuneus(BiPc)and bilateral occipital lobe(BiOL)(P<0.05,FEW corrected).The patients with anti-NMDAR encephalitis showed increased negative CBF connectivity between the BiPc,BiOL and Linsula,LTL(P<0.05,FEW corrected).Conclusions The clinical symptoms in patients with anti-NMDAR encephalitis may be associated with both regional CBF differences and CBF connectivity alterations.

关 键 词：抗N-甲基-D-天冬氨酸受体脑炎 动脉自旋标记 脑血流 

分 类 号：R512.3[医药卫生—内科学]