原发性失眠患者前额叶背外侧区静息态功能连接的研究

Dorsolateral prefrontal cortex connectivity in patients with primary insomnia： evidence from resting state functional magnetic resonance imaging

目的 通过对原发性失眠患者前额叶背外侧区功能连接的研究,探讨其认知损害的机制.方法 选择2011年4月至2013年4月郑州大学人民医院神经内科筛选的原发性失眠患者40例和健康对照者50名.利用世界卫生组织-加利福尼亚听觉词语学习测验（WHO-UCLAAVLT）、划销试验评价其词语学习能力和警觉性;利用静息态磁共振扫描观察左、右前额叶背外侧区功能连接.结果 原发性失眠组匹兹堡睡眠质量指数[2.00 （1.00,3.00）]和汉密尔顿焦虑量表分值[13.00 （11.25,15.75）]明显高于对照组[11.00 （9.00,13.00）,1.00 （0,2.00）,Z=-5.517,Z=-5.525,与P＜0.01];数字划销试验工作效率（60.03％±13.95％与66.32％±13.73％,t=2.142,P＜0.05）和WHO-UCLA词语学习能力（分）明显低于对照组（10.11±2.29与11.95±2.42,t=-3.493,P＜0.01）;原发性失眠组与对照组比较右前额背外侧区与右额运动前区连接减弱（-2.610 3 ±0.172 6,t=-3.504,P＜0.05）,左前额背外侧区与双侧岛叶及右额叶功能连接增强（2.820 4±0.326 5,2.371 7±0.106 6,2.492 6±0.052 8,t=4.032,t=3.340,t=3.037,均P＜0.05）.结论 原发性失眠患者词语学习能力及数字划销工作效率下降,其前额叶背外侧区功能连接异常,可能是原发性失眠患者认知、情绪损害的机制之一.

Objective To investigate cognitive impairment mechanism by studying dorsolateral prefrontal cortex connectivity in patients with primary insomnia.Methods Forty patients with primary insomnia and 50 healthy subjects from the Department of Neurology,People＇s Hospital of Zhengzhou University during the period April 2011 through April 2013 were included.The World Health OrganizationUniversity of California Los Angeles Auditory Verbal Learning Test （WHO-UCLA AVLT） and the digital pin test were applied to evaluate the subjects＇ word study ability and vigilance.Resting state functional magnetic resonance imaging was used to observe the connectivity of dorsolateral prefrontal cortex.Results The Pittsburgh Sleep Quality Index （2.00 （1.00,3.00）） and the Hamilton Anxiety Scale scores （13.00 （11.25,15.75）） of primary insomnia patients were significantly higher than that of healthy controls （11.00（9.00,13.00）,1.00 （0,2.00）,Z=-5.517,Z=-5.525,P＜0.01）.Digital pin test efficiency （60.03％ ± 13.95％ vs 66.32％ ± 13.73％,t =2.142,P＜0.05） and WHO-UCLA word learning （10.11 ± 2.29 vs 11.95 ± 2.42,t =-3.493,P ＜ 0.01） of primary insomnia patients were significantly lower than that of healthy controls.Compared to the healthy controls,the right dorsolateral prefrontal cortex of primary insomnia patients exhibited decreased functional connectivity of the right prefrontal lobe （-2.610 3 ± 0.172 6,t =-3.504,P ＜ 0.05）.The left dorsolateral prefrontal cortex of primary insomnia patients exhibited increased functional connectivity of the bilateral insular lobes and right prefrontal lobe （2.8204±0.326 5,2.371 7 ±0.106 6,2.492 6 ±0.052 8,t =4.032,t =3.340,t =3.037,P ＜0.05）.Conclusions The ability of WHO-UCLA word study and the digital pin test efficiency have been shown to decline in patients with primary insomnia.The possible mechanism of cognitive impairment may be the abnormal dorsolateral prefrontal cortex connectivity in patients with primary insomnia.