严重与非严重原发性单症状性夜遗尿症患儿静息态磁共振局部一致性研究  

Regional homogeneity in children with severe and non-severe primary monosymptomatic nocturnal enuresis using resting-state functional magnetic resonance imaging

作　　者：王钏宇 贾智明 朱文[1] 张晨阳[1] 车英玉[2] 吴玥 张静[2] 张钦涌 王焱[1] 文建国[1] 王庆伟[1] Wang Chuanyu;Jia Zhiming;Zhu Wen;Zhang Chenyang;Che yingyu;Wu Yue;Zhang Jing;Zhang QinYong;Wang Yan;Wen Jianguo;Wang qingwei(Department of Urology,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China;Department of Magnetic Resonance,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院泌尿外科,郑州450052 [2]郑州大学第一附属医院磁共振科,郑州450052

出　　处：《临床小儿外科杂志》2022年第4期347-352,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(81670689,U1904208);河南省医学攻关科技计划(LHGJ20190167)。

摘　　要：目的采用静息态功能磁共振成像(resting-state functional magnetic resonance imaging,Rs-fMRI)技术,探讨严重与非严重原发性单症状性夜遗尿症(primary monosymptomatic nocturnal enuresis,PMNE)患儿在疾病效应下局部一致性(regional homogeneity,ReHo)上的改变和差异。方法选取2017年6月至2021年2月就诊于郑州大学第一附属医院泌尿外科尿控诊疗中心的39例PMNE患儿作为研究对象,其中男20例,女19例,年龄(11.9±2.6)岁。选取33例因上尿路疾病需要手术治疗而常规尿动力学检查证实下尿路功能正常的患儿作为对照组,其中男18例,女15例,年龄(11.8±3.0)岁。将PMNE患儿按照每周夜晚尿床天数分为PMNE非严重组(每周夜晚尿床天数≤4 d,n=14)和PMNE严重组(每周夜晚尿床天数>4 d,n=25);采集所有入组儿童的Rs-fMRI图像,采用单因素方差分析比较各组之间疾病效应下的ReHo差异,并采用双样本t检验进行事后检验,比较三组脑功能特征。结果疾病效应脑区为辅助运动区。PMNE非严重组与PMNE严重组比较,ReHo差异无统计学意义(P>0.05)。相较于对照组,PMNE非严重组患儿左侧顶下小叶、左侧额下回及辅助运动区异常,严重组右侧颞下回、左侧额上回及辅助运动区异常。上述结果均行AlphaSim校正P<0.005,矫正后P<0.05,差异均有统计学意义。结论PMNE非严重组患儿存在顶下小叶、额下回及辅助运动区功能异常,PMNE严重组患儿存在颞下回、额上回和辅助运动区功能异常。这些异常脑区可能与PMNE的病理机制有关。而PMNE患儿症状严重程度可能与中枢神经系统发育程度无关。Objective To explore the change and difference of regional homogeneity(ReHo)in children with severe and non-severe primary monosymptomatic nocturnal enuresis(PMNE)using resting-state functional magnetic resonance imaging(Rs-fMRI).Methods A total of 39 PMNE children were selected as research subjects.There were 20 boys and 19 girls with an age range of(11.9±2.6)years.And 33 children with normal lower urinary tract function confirmed by conventional urodynamic and requiring surgery for upper urinary tract diseases were selected as normal control group.According to the weekly frequency of bed wetting nights,PMNE children were divided into two groups of non-severe(bed wetting nights per week≤4)(n=14)and severe(bed wetting nights per week>4)(n=25).Rs-fMRI images were acquired and ReHo difference under the effect of disease was analyzed by one-way ANOVA.Two-sample post hoc t-test was utilized for comparing the differences of brain function characteristics among three groups.Results The dominant disease-affected brain region was supplementary motor area.No statistical difference existed in ReHo between non-severe and severe groups.As compared with control group,left inferior parietal lobule,left inferior frontal gyrus and supplementary motor area were abnormal in non-severe group;right inferior temporal gyrus,left superior frontal gyrus and supplementary motor area were abnormal in severe group.All of the above results were corrected by AlphaSim correction(voxel level P<0.005,P<0.05 after correction were considered statistically different).Conclusion Abnormal functions of inferior parietal lobe,inferior frontal gyrus and supplementary motor area were present in non-severe group and abnormal functions of inferior temporal gyrus,superior frontal gyrus and supplementary motor area in severe group.These abnormal brain regions may be related with the pathological mechanism of PMNE.And the severity of symptoms may not be related with the development of central nervous system in PMNE children.

关 键 词：夜遗尿症/影像诊断 夜遗尿症/诊断 脑/影像诊断 静息态功能磁共振 

分 类 号：R445.2[医药卫生—影像医学与核医学] R726.9[医药卫生—诊断学]