双位点重复经颅磁刺激对主观耳鸣患者脑区功能改变的研究  

Effect of dual-site repetitive transcranial magnetic stimulation on the changes of brain function in patients with subjective tinnitus

作　　者：荆国庆 文凤 余露 韩祺 武文婧 张杨 JING Guo-qing;WEN Feng;YU Lu;HAN Qi;WU Wen-jing;ZHANG Yang(Department of Radiology,the First Hospital Affiliated to Army Medical University,Chongqing 400038,China;7T Magnetic Resonance Imaging Translational Medical Center,the First Hospital Affiliated to Army Medical University,Chongqing 400038,China;Department of Otolaryngology,the First Hospital Affiliated to Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院放射科,重庆400038 [2]陆军军医大学第一附属医院7T磁共振转化医学中心,重庆400038 [3]陆军军医大学第一附属医院耳鼻喉科,重庆400038

出　　处：《局解手术学杂志》2025年第4期305-309,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市自然科学基金面上项目(cstc2020jcyj-msxmX0072)。

摘　　要：目的通过静息态功能磁共振成像(rs-fMRI)检测主观耳鸣(ST)患者经“额-颞”双位点重复经颅磁刺激(rTMS)治疗后全脑功能改变的特点。方法纳入45例ST患者,在“额-颞”双位点rTMS治疗前和治疗后2周进行耳鸣严重程度评估及rs-fMRI扫描,并分析ST患者治疗前后的局部一致性(ReHo)、分数低频振幅(fALFF)、度中心度(DC)及基于以上的种子点功能连接(FC)等指标。结果与治疗前相比,ST患者经治疗后2周的耳鸣残疾量表(THI)评分显著降低(P<0.001)。与治疗前相比,ST患者经治疗后2周右侧顶下小叶的ReHo值降低,右侧颞极的fALFF值升高,右侧颞上回的fALFF值降低,右侧颞中回DC(weighted)和DC(Binarized)值均降低(P<0.05,GRF校正)。分别以上述差异脑区作为种子点进行FC分析,与治疗前相比,治疗后2周右侧颞上回(fALFF)与右侧颞中回间的FC减少,右侧颞中回[DC(weighted)]与右侧枕上回间的FC减少,右侧颞中回[DC(Binarized)]与右侧枕上回间的FC减少(P<0.05,GRF校正)。结论“额-颞”双位点rTMS治疗ST患者初步有效,且ST患者在治疗后的听觉和非听觉脑区发生不同程度的局部和脑区间脑功能改变,主要累及默认模式网络及视听觉网络。Objective To detect the characteristics of whole-brain functional changes in patients with subjective tinnitus(ST)after"frontal-temporal"dual-site repetitive transcranial magnetic stimulation(rTMS)by resting-state functional magnetic resonance imaging(rs-fMRI).Methods A total of 45 ST patients were enrolled,and assessments of tinnitus severity and rs-fMRI scans were performed before and 2 weeks after treatment with"frontal-temporal"dual-site rTMS.Regional homogeneity(ReHo),fractional amplitude of low-frequency fluctuations(fALFF),degree centrality(DC)and seed-based functional connectivity(FC)were analyzed before and after treatment in ST patients.Results Tinnitus handicap inventory(THI)score of ST patients 2 weeks after treatment was significantly decreased compared with that before treatment(P<0.001).ReHo values of the right inferior parietal lobule decreased,fALFF values of the right temporal pole increased,fALFF values of the right superior temporal gyrus decreased,and DC(weighted)and DC(Binarized)values of the right medial temporal gyrus all decreased in ST patients 2 weeks after treatment compared with those before treatment(P<0.05,GRF correction).Using the above differential brain regions as seed points for FC analysis,FC values between right superior temporal gyrus(fALFF)and right middle temporal gyrus reduced,FC values between right middle temporal gyrus[(DC(weighted)]and right superior occipital gyrus reduced,and FC values between right middle temporal gyrus[DC(Binarized)]and right superior occipital gyrus reduced 2 weeks after treatment compared with those before treatment(P<0.05,GRF correction).Conclusion"Frontal-temporal"dual-site rTMS is initially effective for ST patients,and the auditory and non-auditory brain regions of ST patients showed different degrees of regional and interbrain function changes,mainly involving default mode network and visual-auditory network.

关 键 词：重复经颅磁刺激 主观耳鸣 局部一致性 分数低频振幅 度中心度 静息状态功能磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]