成人注意缺陷多动障碍静息态功能连接分析

Resting-state functional connectivity analysis of adult attention deficit hyperactivity disorder

目的：注意缺陷多动障碍（Attention Deficit Hyperactivity Disorder,ADHD）是一种在儿童期多发的疾病,对ADHD的研究也主要集中在儿童期疾病,却往往忽略了占有相当大比例的成年人,大部分的成人患者都是从儿童期疾病发展而来的,因此进一步研究成人期的疾病信息对于ADHD的致病机理和疾病在成长发育中的延续变化具有显著的意义。本文旨在通过静息态功能磁共振成像的方法从功能连接的角度来研究成人患者在情感和认知方面存在的脑区异常,并试图对比疾病在儿童期和成人期的差异。对象与方法：实验对象有成人ADHD患者组和成人正常对照组,分别20例,年龄20岁~50岁,均无其他人口统计学差异。分别获取两组被试的静息态功能磁共振数据,预处理后基于成人ADHD前扣带回（ACC）头尾部也存在情感和认知功能分离的假设,均选取两组被试在MNI坐标下的ACC头尾部两个感兴趣种子区域ROI1（5,2,46）和ROI2（5,34,14）,并进行感兴趣区域与全脑的功能连接计算以及功能连接的单样本、双样本t检验的统计分析。从统计分析可以得出两组被试的两个感兴趣区域分别与全脑显著相关的脑区分布,患者组与正常对照组在相应的功能连接结果中的差异脑区以及t值峰值坐标位置。结果与结论：在单样本t检验中,ADHD成人患者组和正常被试组ACC头尾部的两个感兴趣位点与全脑的功能连接中存在情感和认知功能分离的现象,即背侧尾部区域与运动辅助区等认知执行相关脑区相关,腹侧头部区域则参与下前扣带回等情感过程。在双样本t检验中,ADHD成人患者组相对于正常组在两个感兴趣区域与情感相关的脑区功能连接中,部分脑区连接增强部分脑区连接减弱;与运动相关脑区的功能连接没有明显差异;成人ADHD组的ACC头尾部与部分注意网络区域功能连接增强,与默认网络部分区域功能连接减弱。因此,ACC头尾部在人类情感和认知过程中存在重要影响,而且成人和儿童ADHD患者的ACC头尾部与全脑功能连接可能存在显著意义的差异。

Objective Attention deficit hyperactivity disorder （ADHD） is a kind of common disease in young children, so the researches mainly focus on the ADHD in childhood. However, a large number of adults with ADHD is often ignored. Most adult patients has developed ADHD since childhood, so further research on adult ADHD is of remarkable significance for its pathogenic mechanism and changes along with ages. From the point of functional connectivity, resting-state functional magnetic resonance imaging （RS-fMRI） was applied to study on the abnormal conditions of brain regions of adult patients in emotion and cognition, and to contrast the differences between ADHD in adult and childhood. Methods There were adult ADHD group and normal group, each group of 20 cases, aged 20-50 years old. And there were no other demographic differences in these two group. The RS-tMRI data of these two groups were obtained. Based on the hypothesis that the head and tail of the anterior cingulate cortex （ACC） of adult with ADHD showed emotional and cognitive functional separation, the two seed regions of interest （ROIs） at the head and tail of ACC in both groups, ROll （5, 2, 46） and ROI2 （5, 34, 14） in MNI coordinate, were selected to calculate the functional connectivity between ROIs and the whole brain and to statistically analyze the results of one-sample T test and two-sample T test of functional connectivity. According to the statistical analysis, the brain regions significantly correlated to the selected ROIs could be found. The brain regions with different functional connectivity between adult ADHD group and normal group were obtained. And the coordinate of T peak value was also obtained. Results and conclusion The one-sample T test showed that emotional and cognitive functional separation existed in the functional connectivity between ROIs at the head and tail of ACC and whole brain in these two groups. Dorsal region of ACC tail and supplementary motor area were associated with the brain region related to cognition and process, while ventral region of ACC head was involved in emotional process of anterior cingulate and so on. The two-sample T test showed that the functional connectivity between the ROls and some brain regions related to emotion in adult ADHD group was stronger than that in normal group, while the functional connectivity in other emotional areas in adult ADHD group was weaker than that in nonnaI group. No obvious differences were found in the functional connectivity in the brain areas involved motor. For adult patients, the head and tail of ACC had a stronger connection to some areas of dorsal attention network and weaker connection to the areas of default network. ACC is of great importance on human emotion and cognition. The functional connectivity between the head and tail of ACC and the whole brain shows significant differences between the adult patients and young patients.