空间工作记忆任务态fMRI在原发性失眠患者认知功能障碍评价中的应用

Application of spatial working memory task fMRI in evaluation of primary insomnia patient＆#39;s cognitive dysfunction

目的 采用空间工作记忆任务态fMRI技术,探讨原发性失眠（PI）患者异常激活脑区其发生的神经病理机制.方法 选择2013年7-12月郑州大学人民医院神经内科符合美国精神疾病诊断与统计手册第4版（DSM-Ⅳ）和中国精神障碍分类与诊断标准（CCMD-3）、脑部结构正常的原发性失眠（PI）组30例,年龄、性别与之一致的健康对照组30例,所有受试者均进行临床匹兹堡睡眠质量指数（PSQI）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）、空间工作记忆相关量表测定及3.0T常规磁共振扫描、空间工作记忆任务态fMRI成像.比较PI组、健康对照组临床量表及任务态fMRI激活脑区差异.结果 PI组PSQI、HAMD、HAMA、空间工作记忆量表与健康对照组对比差异均有统计学意义（均P＜0.05）.PI组、健康对照组空间工作任务态fMRI激活脑区对比,PI组激活增强脑区包括：右侧额叶、左侧枕叶、左颞叶;PI组激活减弱脑区包括：双侧额叶皮质、双侧顶上小叶侧、左海马旁回、右侧海马旁回、双侧颞叶皮质.结论 空间工作记忆任务态fMRI成像揭示了原发性失眠患者临床认知功能障碍及情绪调节失常神经病理机制.

Objective To explore abnormal brain activation of spatial working memory in primary insomnia and its potential neuromechanism.Methods we recruited 30 cases primary insomnia （PI） patients and 30 cases age,gender matched healthy control （HC） subjects from July 2013 to December 2013,the diagnosis of primary insomnia matched the diagnosis criterion of DSM-Ⅳ and Classification and diagnostic criteria of mental disorders in China third edition （CCMD-3）.All the subjects attended the tests of PSQI,HAMA,HAMD and index of spatial working memory.And then,we collected the data of routine MRI and spatial working memory task fMRI on 3.0 T MRI scanner.After that,we used SPM8 and REST1.8 to analyze the fMRI data,compared difference of PSQI,HAMA,HAMD,index of spatial working memory and brain activation of spatial working memory between PI group and HC group.Results There were significant difference between PI group and HC group in PSQI,HAMA,HAMD and index of spatial working memory （P 〈 0.05）.In the spatial working memory related activate brain region,compared with HC group,left temporal lobe,occipital lobe and right frontal lobe activation increased and bilateral parahippocampalis,temporal cortex,frontal cortex and superior parietal lobule activation reduced in PI group.Conclusion Spatial working memory task fMRI revealed the pathological mechanisms of cognitive dysfunction of clinical spatial working memory and emotional disorder in primary insomnia patients.