基于静息态功能磁共振成像的慢性嗜酒者双侧杏仁核全脑功能连接研究

Whole brain functional connectivity of the bilateral amygdaloid in chronic alcoholics： a resting-state functional magnetic resonance imaging study

目的探讨慢性嗜酒者静息状态下的双侧杏仁核全脑功能连接（FC）情况。方法选取33名慢性嗜酒者（慢性嗜酒组1及36名性别、年龄、受教育程度与之相匹配的健康志愿者（正常对照组），所有被试者均完成密歇根酒精筛查量表（MAST）和酒精成瘾量表（ADS）评分；使用MRI采集所有被试的静息态数据；数据处理及统计分析采用统计参数图（SPM51及REST运行环境下的DPARSF软件。利用REST软件分别取得左侧杏仁核活性峰值体素（-24，0，-16）和右侧杏仁核峰值体素（24，0，16）作为种子点，得到全脑FC统计图；对2组FC预处理数据行双样本t检验，将受试者差异具有统计学意义的资料作为协变量。采用REST软件Slice Viewer功能查看结果，将经过Alphasim多重比较校正（FWHM=4，rmm=4，P=0．050）得到的连续体素〉54个体素（1458mm^3）的脑区定义为差异有统计学意义的区域；记录各脑区的峰值蒙特利尔神经科学研究所fMNI）坐标，查看其具体解剖位置；分别提取各脑区的时间序列，与MAST、ADS量表评分作相关性分析。结果经头动检测，共12例（正常对照组7例，慢性嗜酒组5例）被试者数据被剔除，最终纳入57例被试者（正常对照组29例，慢性嗜酒组28例）。以左侧杏仁核为种子点，与正常对照组相比，慢性嗜酒组静息态下FC增强的脑区有左侧额下回岛盖部、双侧缘上回、左侧丘脑、双侧中央旁小叶、左侧中央前回、右侧额下回眶部、右侧颞上回，差异有统计学意义（P〈0．05），功能连接减弱的脑区有左侧枕中回、左侧小脑脚、左侧眶额区、左侧嗅皮层、右侧小脑下半月小叶、右侧小脑顶叶、右侧额上回，差异有统计学意R（P〈o．05）。以右侧杏仁核为种子点，与正常对照组相比，慢性嗜酒组静息态下FC增强的脑区有左侧额下回三角部、左侧颞中回、左侧尾状核、左侧楔前叶、左侧中央旁小叶、左侧额中回、右侧角回，差异有统计学意义（P〈0．05），FC减弱的脑区有左侧小脑半球、左侧额眶区、右侧顶上回、延髓，差异有统计学意义（P〈0．05）；其中，慢性嗜酒组左侧额叶与MAST量表评分呈显著负相关（r=．0．433，P=0．021），而左侧楔前叶（r=0．245，P=0．210）、左侧侧缘上回（r=0．187，P=0．341）、右侧缘上回（r=0．142，P=-0．4713）、右侧小脑（r=0．227，P=0．245）与ADS量表评分呈显著正相关。结论慢性嗜酒者左侧杏仁核功能更易受损；杏仁核可能参与前额叶-小脑环路的功能调节，并与酒精相关性脑损害发病机制和临床表现密切相关。

Objective To explore the conditions of whole brain functional connectivity （FC） of the bilateral amygdaloid in resting state in chronic alcoholics. Methods Thirty-three chronic alcoholics and 36 healthy control subjects matched in gender, age, education and handedness, admitted to our hospital from October 2011 to October 2012, were enrolled as chronic alcoholics group and control group, respectively. All subjects were asked to perform both Michigan alcohol screening scale （MAST） and alcohol addiction scale （ADS） to ensure that the alcohol dependent individuals enrolled in this study reached moderate alcohol dependent. All subjects were performed MR imaging; DPARSF software was used to perform data processing which was based on MATLABE, SPM and REST operating environment. REST software was made use of the left amygdala activity peak voxel （-24, 0, -16） and right amygdala peak voxel （24, 0, 16） as seeded region of interest to get the whole brain FC mapping. Rest Slice Viewer software within REST software package was used to view statistical results. Each time series of brain regions were extracted, and correlation analysis of MAST scores with ADS scores was performed and the corresponding correlation coefficient values were recorded. Results Finally, 57 subjects （28 in chronic alcoholics group and 29 in control group） were enrolled after screening. As compared with that in the healthy controls, the FC of left pars opercularis gyri frontalis inferiorista, bilateral supramarginal gyrus, left thalamus, bilateral paracentral lobule, left precentral gyrus, right pars orbitalis gyfi frontalis inferiois and fight superior temporal gyrus was significantly increased in the left amygdaloid, and that of left middle occipital gyrus, left cerebellar peduncle, left orbitofrontal region, lett entorhinal cortex, right cerebellum inferior semi-Lunar lobule, fight cerebellar parietal and superior frontal gyrus was significantly decreased in resting state in chronic alcoholism （P〈0.05）; as compared with that in the control group, the FC of left pars triangularis gyfi frontalis inferiorista, left middle temporal gyms, left caudate nucleus, left precuneus, left paracentral lobule, left middle frontal gyrus and right angular gyrus was significantly increased in the right amygdaloid, and that of left cerebellar hemisphere, left orbifrontal area, fight superior parietal lobule, medulla oblongata was significantly decreased in resting state in chronic alcoholism （P〈0.05）. In the chronic alcoholics group, the left frontal lobe was significantly negatively correlated with MAST scores （r=-0.433, P=0.021）; the left precuneus （r=0.245, P=0.210）, left supramarginal gyrus（r=0.187, P=0.341）, fight supramarginal gyrus（r=0.142, P=0.471） and right cerebellum （r=0.227, P=0.245 ） showed a significant positive correlation with ADS scores. Conclusion Left amygdale＇s function of chronic alcoholics is more easily damaged; amygdala may be involved in regulating the function of fronto-cerebellar loops, and has close relation with alcohol-related brain damage in the pathogenesis and clinical manifestations.