神经精神性狼疮患者局部一致性动态变化的功能磁共振研究  

A Functional Magnetic Resonance Imaging Study on the Dynamic Changes of Regional Homogeneity in Patients with Neuropsychiatric Lupus

作　　者：李一凡 沈华宇 高俊逸 孙中茹 朱萌 夏建国[1] 张继 田为中 LI Yifan;SHEN Huayu;GAO Junyi(Department of Imaging,The Affiliated Taizhou People's Hospital of Nanjing Medical University,Taizhou,Jiangsu Province 225300,P.R.China)

机构地区：[1]南京医科大学附属泰州人民医院影像科,泰州225300 [2]南京医科大学附属泰州人民医院麻醉科,泰州225300

出　　处：《临床放射学杂志》2025年第5期808-813,共6页Journal of Clinical Radiology

基　　金：江苏省卫健委科研课题项目(编号:H2018093);江苏省第五期“333工程”科研项目(编号:BRA2017175)。

摘　　要：目的通过动态局部一致性(dReHo)探讨神经精神性狼疮(NPSLE)患者脑内在局部连通性改变及其与临床资料相关性。方法前瞻性纳入35例NPSLE患者,30例非NPSLE患者为病例组,同期纳入31名健康志愿者作为对照组(HC组),行高分辨率3D-T1WI及静息态功能磁共振成像(rs-fMRI),并完善简易精神状态量表(MMSE)、医院焦虑抑郁量表(HADS-A、HADS-D)、运动和认知功能疲劳量表(FSMC-M、FSMC-C)及实验室检查(C3、C4、IgA、IgM、IgG)。利用滑动时间窗方法计算dReHo指标。偏相关方法探索NPSLE组与非NPSLE组差异脑区dReHo值与神经心理学量表及临床指标的相关性。通过受试者工作特征曲线(ROC)分析dReHo指标鉴别NPSLE组及非NPSLE组的效能。结果三组间协方差分析显示,受试者组间dReHo差异脑区是左侧回直肌、右侧距状裂周围皮层、左侧枕中回、右侧枕中回、左侧楔前叶、左侧颞中回、右侧颞中回(FWE校正,体素水平P<0.001,团块水平P<0.05);进一步事后分析可知,与HC组相比,NPSLE组上述脑区dReHo值均升高,非NPSLE组左侧回直肌dReHo值升高(P均<0.05);与非NPSLE组相比,NPSLE组上述脑区dReHo值均升高(P均<0.05)。偏相关性分析显示,相对于非NPSLE组,NPSLE组右侧枕中回dReHo值与HADS-D评分呈正相关(r=0.393,P=0.026)。ROC分析发现,NPSLE组与非NPSLE组大部分差异脑区曲线下面积(AUC)值为0.7~0.9,其中右侧枕中回dReHo值效能较高。结论NPSLE患者多个脑区动态局部一致性升高,集中于默认模式网络(DMN)、视觉注意网络及边缘系统,同时NPSLE患者右侧枕中回dReHo值与抑郁情绪相关,且鉴别诊断效能最高,具有一定的临床意义。Objective To investigate the alterations in intrinsic regional brain connectivity and their correlation with clinical data in patients with neuropsychiatric systemic lupus erythematosus(NPSLE)using dynamic regional homogeneity(dReHo).Methods This prospective study included 35 patients with NPSLE,30 patients with non-neuropsychiatric systemic lupus erythematosus(non-NPSLE)as the case group,and 31 healthy controls(HC)as the control group.High-resolution 3D T 1-weighted imaging(3D-T 1WI)and resting-state functional magnetic resonance imaging(rs-fMRI)were performed.Clinical assessments included the Mini-Mental State Examination(MMSE),the Hospital Anxiety and Depression Scale(HADS-A,HADS-D),the Fatigue Scale for Motor and Cognitive Functions(FSMC-M,FSMC-C),and laboratory tests(C3,C4,IgA,IgM,IgG).The sliding time window method was used to calculate dReHo.Partial correlation analysis was employed to explore the relationship between dReHo values in brain regions with significant differences between the NPSLE and non-NPSLE groups and neuropsychological and clinical data.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic efficacy of dReHo in distinguishing NPSLE from non-NPSLE.Results Group Differences in dReHo:Covariance analysis revealed significant intergroup differences in dReHo values in the following brain regions:the left rectus gyrus,right pericalcarine cortex,left middle occipital gyrus,right middle occipital gyrus,left precuneus,left middle temporal gyrus,and right middle temporal gyrus(FWE-corrected,voxel-level P<0.001,cluster-level P<0.05).Post hoc analysis indicated that compared to the HC group,dReHo values were increased in the above brain regions in the NPSLE group and in the left rectus gyrus in the non-NPSLE group(P<0.05).Compared to the non-NPSLE group,dReHo values were significantly elevated in these brain regions in the NPSLE group(P<0.05).Correlation Analysis:Partial correlation analysis showed that in the NPSLE group,dReHo in the right middle occipital gyrus was

关 键 词：神经精神性狼疮 动态局部一致性 静息态 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]