基于种子点的功能连接对轻微型肝性脑病患者默认网络的研究  

A study of the seed-point functional connectivity network for the default mode network in patients withmild hepatic encephalopathy

作　　者：牛芳 郑佳瑞 马文富 马万龙 金一萱 孙萌 丁向春[3] 王晓东[4,5] NIU Fang;ZHENG Jiarui;MA Wenfu;MA Wanlong;JIN Yixuan;SUN Meng;DING Xiangchun;WANG Xiaodong(Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China;Department of Radiology,Yinchuan Maternal and Child Health Care Hospital(Yinchuan Children's Hospital),Yinchuan 750004,China;Department of Infectious Diseases,the General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Radiology,the General Hospital of Ningxia Medical University,Yinchuan 750004,China;Key Laboratory of Brain Diseases,the General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学临床医学院,银川750004 [2]银川市妇幼保健院(银川市儿童医院)放射科,银川750004 [3]宁夏医科大学总医院感染疾病科,银川750004 [4]宁夏医科大学总医院放射科,银川750004 [5]宁夏医科大学颅脑疾病重点实验室,银川750004

出　　处：《磁共振成像》2024年第11期1-5,11,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家科学自然基金项目孵育计划项目(编号:宁医大总院[2021]468号);宁夏回族自治区科技重点研发计划项目(编号:2019BEG03037);宁夏回族自治区自然科学基金项目(编号:2022AAC03487)。

摘　　要：目的应用静息态功能磁共振成像(resting-state function magnetic resonance imaging,rs-fMRI)技术结合基于种子点的功能连接(functionalconnectivity,FC)分析方法研究乙型病毒性肝炎相关的慢加急性肝衰竭(hepatitisBvirus-related acute-on-chronicliverfailure,HBV-ACLF)伴轻微型肝性脑病(minimalhepaticencephalopathy,MHE)患者和健康对照者(healthy controls,HCs)的默认网络(default mode network,DMN)与全脑的FC是否存在差异,进一步探究HBV-ACLF伴MHE患者认知功能障碍的潜在机制,并以期为HBV-ACLF伴MHE早期诊断提供影像标志物。材料与方法采用rs-fMRI技术,观察27例HBV-ACLF伴MHE患者和22例HCs静息态下DMN与全脑的FC情况,分析两组间的差异,并与数字符号实验(Digit Symbol Test,DST)评分、数字连接实验A(Number Connection Test A,NCT-A)评分、蒙特利尔认知评估(Montreal Cognitive Assessment,MoCA)量表评分、血氨及白细胞计数进行相关性分析。结果与HCs组相比,MHE组右侧颞极、左侧颞下回、右侧枕下回及左侧枕中回FC减低(P<0.005);MHE组右侧颞极(颞中回)FC值与MoCA评分呈显著负相关(r=-0.394,P<0.05);MHE组左侧颞下回FC值与血氨呈显著负相关(r=-0.456,P<0.05)。结论HBV-ACLF伴MHE患者DMN内部功能整合发生了改变,FC减退或中断可能为HBV-ACLF伴MHE患者早期认知减退的病理生理学机制。Objective:Resting-state functional magnetic resonance imaging(rs-fMRI)combined with seed-based functional connectivity(FC)analysis was used to investigate whether there was a difference between the default network(DMN)and the whole brain functional connectivity between patients with hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)and minimal hepatic encephalopathy(MHE)and healthy controls(HCs),in order to further explore the underlying mechanism of cognitive dysfunction in HBV-ACLF with MHE patients and HCs,and to provide imaging markers for early diagnosis of HBV-ACLF with MHE.Materials and Methods:Rs-fMRI was used to observed the FC of the DMN with the whole brain in 27 patients with HBV-ACLF with MHE and 22 HCs in the resting state,and analyze the differences between the two groups,and correlation analysis was performed with Digit Symbol Test(DST),Number Connection Test A(NCT-A),Montreal Cognitive Assessment(MoCA)scores,blood ammonia and white blood cell count.Results:Compared with the HCs group,the FC of the right temporal pole(middle temporal gyrus),left inferior temporal gyrus,right inferior occipital gyrus and left middle occipital gyrus was reduced in the MHE group(P<0.005),the FC value of the right temporal pole was significantly negatively correlated with the MoCA score in the MHE group(r=−0.394,P<0.05),and the FC score of the left inferior temporal gyrus in the MHE group was significantly negatively correlated with blood ammonia(r=−0.456,P<0.05).Conclusions:The internal functional integration of DMN in patients with HBV-ACLF with MHE is altered,and the reduction or interruption of FC may be the pathophysiological mechanism of early cognitive decline in patients with HBV-ACLF with MHE.

关 键 词：轻微型肝性脑病 磁共振成像 静息态功能连接 心理测试 默认网络 认知功能 

分 类 号：R445.2[医药卫生—影像医学与核医学] R747.9[医药卫生—诊断学]