基于fMRI观察益肾逐瘀法对帕金森病患者脑网络连接的影响

Effect of Yishen Zhuyu Therapy on striatal-cortical functional connectivity of patients with Parkinson's Disease based on fMRI

目的研究帕金森病(PD)患者纹状体与大脑皮层功能连接的特征,并探讨益肾逐瘀法对纹状体-皮层功能网络的影响。方法使用益肾逐瘀法治疗PD患者,疗程4周,对PD患者和健康对照各9例行静息态功能磁共振检查,在每个半球中以基于皮层的功能分区与4个纹状体亚区的偏相关系数为脑网络特征,采用最小绝对收缩与选择套索算法(LASSO)挑选出最优特征,将PD患者和对照组,以及PD患者治疗后与治疗前进行分类,并对PD患者病程及统一帕金森病评定量表-运动检查(UPDRSⅢ)进行线性回归。结果 PD患者的纹状体与运动感觉网络和中央执行网络的连接度减弱,病程和UPDRSⅢ均与壳核后部-默认网络的连接呈正相关,UPDRSⅢ与尾状核-视觉网络、伏隔核-中央执行网络的连接呈负相关。经治疗后,PD患者的中医证候量表评分较治疗前明显改善,且主要体现在非运动症状的改善,尤以腰膝酸软,精神萎靡,夜尿频,刺痛、痛有定处最为显著。伏隔核-中央执行网络连接度较治疗前有所增强。结论 PD患者运动、感觉及认知网络与纹状体的连接较健康对照均有改变,并与病程延长和病情严重程度相关。益肾逐瘀法对PD有一定治疗作用,以改善非运动症状为主,对重建PD患者伏隔核(奖赏环路中的关键区域)与中央执行网络的连接有着积极的作用。

Objective To explore the characteristics of functional connection between striatum and cerebral cortex in Parkinson's Disease (PD)patients,and to probe the effect of Yishen Zhuyu therapy on striatum-cortical function network.Methods PD patients were treated with Yishen Zhuyu Decoction for 4 weeks.Resting functional magnetic resonance imaging was applied to 9 patients and 9 healthy controls. The partial correlation coefficients between 4 striatum parts and cortex based functional parcellation of each hemisphere were taken as features of brain networks.Lasso algorithm was employed to find the optimal features in classification of PD patients and healthy controls,along with in classification of PD patients'baseline and after treatment.Linear regression using Lasso was also applied to find the most relevant features in predicting UPDRS Ⅲ and the duration of disease.Results The functional connectivity between striatum and motor-sensory network as well as central executive network were decreased in PD patients.The course of disease and UPDRS Ⅲ were both positively correlated with the correlation between posterior putamen and default mode network.UPDRS Ⅲ was negatively correlated with the correlation between caudate and visual network.After treatment,the grade of quantitative classification table of syndrome declines significantly,meanwhile,the connectivity between the nucleus accumbens and the central executive network has been enhanced.Conclusion The functional connectivity between striatum and motor-sensory network as well as cognitive networks are altered in PD patients.These alterations are correlated with prolongation and severity of the disease.The method of Yishenzhuyu decoction has a therapeutic effect in PD,and has a positive effect in rebuiding the connection between nucleus accumbens which is the key part of reward circuit,and central executive network.