严重脑损伤后不同意识水平患者关键脑区的功能差异  

Functional differences in key brain regions in patients with different levels of consciousness after severe brain injury

作　　者：陈伟观[1] 张晔[2] 周玥 徐茜[1] 郭爱松[1] 周学军[3] 宋为群[2] Chen Weiguan;Zhang Ye;Zhou Yue;Xu Xi;Guo Aisong;Zhou Xuejun;Song Weiqun(Department of Rehabilitation Medicine,Affiliated Hospital of Nantong University,Nantong 226001,China;Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Medical Imaging,Affiliated Hospital of Nantong University,Nantong 226001,China)

机构地区：[1]南通大学附属医院康复医学科,南通226001 [2]首都医科大学宣武医院康复医学科,北京100053 [3]南通大学附属医院医学影像科,南通226001

出　　处：《中华神经医学杂志》2022年第6期593-599,共7页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金(81873723、82102658);南通市社会民生科技面上项目(MS12020018)。

摘　　要：目的观察严重脑损伤后不同意识水平患者关键脑区的功能差异,为慢性意识障碍客观评价指标的明确提供帮助。方法选择南通大学附属医院康复医学科自2016年1月至2020年12月收治的30例严重脑损伤(伤后初始格拉斯哥昏迷量表评分<9分)后患者(均为右利手)为研究对象,依据昏迷恢复量表修订版(CRS-R)评分评估患者的意识水平,并结合慢性意识障碍的诊断定义,将其分为无反应性觉醒综合征/植物状态(UWS/VS)组(8例)、微意识状态(MCS)组(8例)、脱离微意识状态(eMCS)组(6例)、闭锁综合征(LIS)组(8例)。采用局部一致性(ReHo)方法分析不同意识水平患者间静息态功能磁共振成像(rs-fMRI)数据的差异。结果UWS/VS组患者静息态活动增强区域在右侧颞中回,MCS组患者静息态活动增强区域在左侧小脑顶和左侧顶下小叶,eMCS组患者静息态活动增强区域在左侧枕上回和左侧额下回,LIS组患者静息态活动增强区域在左侧颞下回和左侧扣带回。UWS/VS组患者相对MCS组ReHo值显著减弱的峰值脑区在左侧岛叶(体素值1341,t=-5.380,P<0.05);MCS组患者相对eMCS组ReHo值显著减弱的峰值脑区在左侧小脑顶(体素值549,t=-5.377,P<0.05),而ReHo值显著增强的峰值脑区在左侧岛叶(体素值438,t=3.751,P<0.05);MCS组患者相对LIS组ReHo值显著增强的峰值脑区在左侧额内侧回(体素值1014,t=5.406,P<0.05)和左侧额叶外核(体素值229,t=4.115,P<0.05);eMCS组患者相对LIS组ReHo值显著增强的峰值脑区在左侧额内侧回(体素值421,t=3.397,P<0.05)。结论静息态下不同意识水平患者间关键脑区的功能存在显著差异,主要涵盖优势半球、左侧岛叶及小脑,这些区域可能是慢性意识障碍客观评价指标的检测靶区。Objective To observe the functional differences in the key brain areas in patients with different levels of consciousness after severe brain injury,and provide reference for confirming the objective diagnosis indicators for prolonged disorders of consciousness.Methods Thirty right handedness patients with different levels of consciousness after severe brain injury(initial post-traumatic Glasgow coma scale scores<9),admitted to our hospital from January 2016 to December 2020,were chosen in our study.The levels of consciousness of these patients were assessed by revised Coma Recovery Scale(CRS-R);according to the diagnostic criteria of prolonged disorders of consciousness,8 patients were into group of unresponsive wakefulness syndrome/vegetative state(UWS/VS),8 patients were into group of micro-conscious state(MCS),6 patients were into group of emergence from MCS(eMCS),and 8 were into group of locked-in syndrome(LIS).The regional homogeneity(ReHo)was used to analyze resting-state functional MRI(rs-fMRI)data to explore the differences of brain functional activity in patients with different levels of consciousness.Results Strong resting-state activities were noted in the right middle temporal gyrus of the UWS/VS patients,the left culmen and inferior parietal lobule of the MCS patients,the left superior occipital gyrus and inferior frontal gyrus of eMCS patients,and the left inferior temporal gyrus and cingulate gyrus of the LIS patients.As compared with that in the UWS/VS patients,the ReHo value of the left insula in the MCS patients was significantly enhanced(voxel=1341,t=-5.380,P<0.05);as compared with the those in the eMCS patients,the peak brain area with reduced ReHo value in the MCS patients was the left culmen(voxel=549,t=-5.377,P<0.05),while the peak brain area with enhanced ReHo value was the left insula(voxel=438,t=3.751,P<0.05);as compared with that in the LIS patients,the peak brain areas of enhanced ReHo in the MCS patients were the left medial frontal gyrus(voxel=1014,t=5.406,P<0.05)and left extra-nucle

关 键 词：慢性意识障碍 静息态功能磁共振成像 局部一致性 意识水平 脑网络功能 

分 类 号：R651.15[医药卫生—外科学]