对车祸后急性应激反应患者静息态功能磁共振脑功能连接密度的观察

Study of functional connectivity density mapping resting-state functional MRI after traffic accident in patients with acute stress response by using

目的采用静息态功能磁共振（fMRI）功能连接密度（FCD）方法探讨车祸创伤幸存者在1周内急性应激状态下脑功能活动的改变，为及时、早期干预提供客观影像学参考。方法对2013年1月至2016年2月收治于南京军区南京总医院的20例处于急性应激状态（急性应激障碍访谈问卷评分〉3）的车祸创伤患者及20名健康志愿者行3．0T静息态fMRI扫描，比较急性应激反应（ASR）创伤组和健康对照组全脑长程及短程FCD的差异，并计算ASR患者FCD异常脑区和临床量表的相关性。结果（1）ASR患者左侧腹内侧前额叶（-0．815±0．264比-0．468±0．615，t=-2．198，P〈0．05）、左侧海马／海马旁回（-1．212±0．135比-0．887±0．234，t=-5．070，均P〈0．05）的短程FCD明显低于健康对照组，而ASR患者右侧中央前回（0．428±0．256比0．016±0．298，t=4．456，P〈0．05）、左侧顶上／顶下小叶（0．623±0．290比0．143±0．300，t=4．878，均P〈0．05）的短程FCD明显高于健康对照组；（2）两组比较，患者左侧楔前叶的长程FCD明显高于健康对照组（0．502±0．400比-0．042±0．253，t=4．879，P〈0．05）；（3）ASR患者的左侧腹内侧前额叶短程FCD值与汉密尔顿焦虑量表评分呈正相关（r=0．50，P〈0．05）。结论车祸后急性应激反应期患者长程及短程FCD均发生改变，主要异常位于前额叶一边缘系统脑区，其中短程FCD的改变更加明显，且与患者的焦虑症状显著相关。

Objective To explore the changes of brain activity in traffic accident survivors with acute stress response within a week by using functional connectivity density （FCD） method. Method A total of 20 traffic accidents survivors with acute stress disorders （acute stress disorder interview 〉 3 ） and twenty healthy controls from Nanjing Jinling Hospital underwent the 3.0 T resting-state functional magnetic resonance imaging scan from January 2013 to February 2016. Functional connectivity density mapping was used to compare the brain functional connective networks between acute stress response survivors and controls. In additional, Pearson correlation was performed between abnormal short, long-range FCD values and clinical indices. Results （ 1 ） Compared with controls, patients with acute stress response showed decreased short-range FCD in left ventromedial prefrontal cortex （ -0. 815 ± 0. 264 vs -0. 468 ± 0. 615, t = - 2. 198, P 〈 0. 05 ）, left hippocampal and parahippocampal gyri （ - 1. 212 ± 0. 135 vs - 0. 887 ± 0. 234）, t = -5.070, all P 〈 0. 05 ）, and increased short-range FCD in right precentral gyrus （0. 428 ± 0. 256 vs 0. 016 ± 0. 298, t = 4. 456, P 〈 0. 05）, left inferior parietal and superior parietal lobes （0. 623 ± 0. 290 vs 0. 143 ± 0. 300, t = 4. 878, all P 〈 0. 05 ） ; （2） compared with normal controls, ASR patients showed increased long-range FCD in left precuneus （0. 502 ± 0. 400 vs - 0. 042 ± 0. 253, t = 4. 879, P 〈 0. 05 ） ; （ 3 ） the HAMA score of patients positively correlated with short-range FCD value of the left vmPFC （ r = 0. 50, P 〈 0. 05 ）. Conclusion The long- and short-range functional connectivity in frontal-limbic system is widely changed in survivors with acute stress response, especially the short-range FCD change more significantly, and partly correlated with the severity of their stress symptoms.