基于fMRI探索伴失眠阴虚火旺型勃起功能障碍患者丘脑功能连接改变  

Changes in the functional connectivity of the thalamus in insomniac ED patients with yin deficiency and fire syndrome:An exploration based on functional MRI findings

作　　者：王雯钰 徐琰 马欣元 杨砚宇 包涵 张子松 陈建淮 陈赟 WANG Wen-yu;XU Yan;MA Xin-yuan;YANG Yan-yu;BAO Han;ZHANG Zi-song;CHEN Jian-huai;CHEN Yun(Taizhou Campus of Nanjing University of Chinese Medicine,Taizhou,Jiangsu 225300,China;Department of Andrology,The Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Provincial Hospital of Chinese Medicine,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京中医药大学泰州校区,江苏泰州225300 [2]南京中医药大学附属医院/江苏省中医院男科,江苏南京210029

出　　处：《中华男科学杂志》2022年第9期822-830,共9页National Journal of Andrology

基　　金：国家自然科学基金(81871154)。

摘　　要：目的:探讨伴失眠阴虚火旺型勃起功能障碍(ED)患者夜间勃起功能与双侧丘脑功能连接(FC)的改变情况。方法:纳入87例阴虚火旺型ED患者与30例健康对照者,其中41例患者伴失眠,46例患者不伴失眠。首先,使用国际勃起功能指数问卷(IIEF-5)和匹兹堡睡眠质量指数量表(PSQI)评估患者夜间勃起功能和睡眠质量,并对各临床指标进行组间比较。其次,对其中15例伴失眠患者、15例不伴失眠患者、30例对照者进行大脑功能核磁共振数据采集与预处理。以双侧丘脑为感兴趣区(ROI),计算全脑FC值,比较ED(伴/不伴失眠)组与对照组各脑区的FC值差异,并使用AlphaSim方法对结果进行多重比较校正。结果:(1)与不伴失眠患者组相比,伴失眠患者组勃起时间、阴茎头部膨胀活动单位和硬度活动单位均下降。(2)以左侧丘脑为ROI,3组差异脑区为右侧额中回和顶下回;与对照组相比,不伴失眠患者组左侧丘脑与左侧眶部额中回、脑岛、壳核以及右侧丘脑FC降低,伴失眠患者组左侧丘脑与双侧额中回、顶下回、矩状裂、海马旁回以及左侧顶上回、右侧楔前叶、右侧颞下回FC降低;与不伴失眠患者组相比,伴失眠患者组左侧丘脑与额中回FC降低。(3)以右侧丘脑为ROI,3组差异脑区为左侧内侧眶部额上回、双侧矩状裂和右侧丘脑;与对照组相比,不伴失眠患者组右侧丘脑(包括右侧丘脑自身)与左侧内侧眶部额上回、颞上回颞极、颞中回、脑岛以及右侧眶部额下回FC降低;伴失眠患者组右侧丘脑与右侧额中回、顶下回、左侧顶上回、矩状裂FC降低;与不伴失眠患者组相比,伴失眠患者组右侧丘脑与内侧眶部额上回FC升高,与左侧矩状裂FC降低。结论:伴失眠ED患者临床症状更严重,且存在特异性丘脑-额叶环路的FC改变,这可能是其ED合并失眠的病理机制所在。Objective:To investigate the changes of nocturnal erectile function and functional connectivity(FC)of bilateral thalami in insomniac ED patients with yin deficiency and fire syndrome.Methods:We enrolled 30 healthy controls and 87 ED patients with yin deficiency and fire syndrome,41 with and the other 46 without insomnia.Using IIEF-5 and Pittsburgh Sleep Quality Index(PSQI),we evaluated the nocturnal erectile function and sleep quality of the patients and compared the clinical indicators between the two groups.Then we collected and preprocessed the MRI data on the cerebral function of the 15 ED patients with insomnia,another 15 without insomnia and the 30 healthy controls.With the thalamus as the region of interest(ROI),we calculated and compared the FC values of brain regions between the ED patients(with or without insomnia)and healthy controls,and corrected the results for multiple comparisons using the AlphaSim method.Results:Compared with the patients without insomnia,those with insomnia had a lower duration of erectile episode and tumescence and rigidity activity units in the tip of the penis.With the left thalamus as the ROI,the right middle frontal gyrus and inferior parietal were shown to be the differential brain regions among the three groups.Compared with the healthy controls,the patients without insomnia showed decreased FC values between the left thalamus and left orbital part of the middle frontal gyrus,insula,putamen and right thalamus,while those with insomnia exhibited decreased FC values between the left thalamus and bilateral middle frontal gyri,inferior parietal,calcarine fissure,parahippocampal gyrus,left superior parietal gyrus,right precuneus and inferior temporal gyrus,and they also exhibited decreased FC values between the left thalamus and middle frontal gyrus in comparison with those without insomnia.With the right thalamus as the ROI,the left medial superior frontal gyrus,bilateral calcarine fissure and right thalamus were found to be the differential brain regions among the three group

关 键 词：勃起功能障碍 失眠 功能核磁磁共振成像 功能连接 丘脑 

分 类 号：R698.1[医药卫生—泌尿科学]