图雷特综合征患者对指运动切换的功能磁共振研究

A finger-taping switch task functional magnetic resonances imaging study in the patients with Tourette＇ s syndrome

目的分析图雷特综合征（TS）患者在运动切换时脑激活特点，初步探讨TS患者抽动触发的可能机制。方法14例鸭患者（TS组）和14名年龄、性别相匹配的健康志愿者（对照组），用3．0T超导磁共振扫描系统进行功能MRI扫描，对比分析在对指运动转换过程中TS患者和健康志愿者的脑激活特点。结果两组受试者激活相同的脑区：对侧的中央前后回、对侧扣带回、对侧额叶内侧回、同侧小脑半球；激活不同的脑区：附加右手对指运动时，左侧中央前后回激活体积（cm^3）TS组（8．024±0．071）大于对照组（6．480±0．026），两者差异有统计学意义（t=3．026，P〈0．01）；附加左手对指运动时，TS组（6．192±0．019）右侧中央前后回的激活体积大于对照组（5．608±0．037），两者差异有统计学意义（t=2．752，P〈0．05）；TS组无岛叶激活，对照组出现对侧岛叶激活；TS组出现对侧丘脑激活，而对照组无丘脑激活。结论丘脑在鸭的发病机制中具有重要的作用，岛叶、扣带回、顶叶皮质环路可能是异样感觉和抽动发作前驱不适的结构和功能基础，TS患者从静止到运动的触发启动和（或）与一种运动到另一种运动的触发启动所需要的条件功能区可能存在差异。

Objective To investigate the central nervous system mechanisms of active of movement switch in the patients with Tourette＇ s syndrome（TS）, and to explore the possible underlying distinct neural networks for tie trigger and generation. Methods Participants were 14 patients with TS and 14 age- and gender-matched healthy volunteers with no history of physical, psychiatric or neurological disease. All patients were assessed with functional magnetic resonances imaging （fMRI） of the brain during the intermittent performance of finger-tapping switch tasks, Blood-oxygen-level dependent-fMRI was performed using a 3.0 Tesla MR. The area over which the activation was distributed was calculated, and the activation volumes were also compared between the patients with TS and the control subjects. Results The regions activated in the patients with TS and in the volunteers were similar in several brain regions, including contralateral precentral and postcentral gyms, contralateral mesia pre-front gyms, contralateral cingnlate gyms, contralateral insula and ipsilataral cerebellum. There were also many different activation areas between the patients and the control subjects. The patients with TS demonstrated more significant and extended activation in the contralateral pre- and postcentral gyms than the healthy volunteers. The volume of the left pre- and postcentral gyrus of the TS patients was （8. 024 ±0. 071 ） cm^3 , while the volume of the left pre-and postcentral gyrus of the control subjects was （ 6. 480 ± 0. 026 ） cm^3 （ t = 3. 026, P 〈 0. 01 ） ; The volume of the right pre- and postcentral gyms was （6. 192 ± 0. 019 ） cm^3 in the TS cases, while there was （5. 608 ± 0. 037） cm^3 in the control subjects （ t = 2. 752, P 〈 0. 05 ）. There were significant differences in the volumes of bilateral pre- and postcetral gyms between the TS and control subjects. The activations of conralateral thalamus without contralateral insula were found in the patients with TS. Conversely, the contralateral insula activation without thalamus activation could be found in the healthy volunteers.Conclusion The thalamus might play an important role in the aetiological and physiopathologic mechanisms of the TS. The thalamus along with the parietal cortex, cingulate cortex and insular cortex appear to constitute a distinct neural network for tic trigger and generation.