脑震荡综合征患者情绪网络的静息态fMRI观察

Resting state fMRI study of emotional network in patients with postconcussion syndrome

目的利用静息态功能磁共振成像（rs－fMRI）探讨脑震荡综合征（PCS）患者情绪网络的功能连接变化及其意义。 方法安徽医科大学附属省立医院神经外科2015年10月至2016年4月接诊的PCS患者27例，同期招募27名健康对照者（HC），采用汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）分别对两组被试的情绪状态进行评分；采集数据并预处理静息态fMRI数据，分别以左右侧杏仁核为感兴趣区（ROI）与全脑进行功能连接计算并做统计学分析，得出PCS患者杏仁核与全脑功能连接有改变的脑区，从而了解情绪网络的功能变化。 结果PCS组与正常对照组相比较，HAMA与HAMD评分（HAMA：PCS组9.8±1.5，正常对照组4.5±1.2，P＝0.044；HAMD：PCS组12±1.2，正常对照组4.2±1.5，P＝0.024）差异有统计学意义。PCS组左侧杏仁核与左侧岛叶、左侧壳核、左侧扣带回前部、左侧额下回眶部、左内侧额叶上回、双侧颞上回、左侧颞上极、双侧缘上回等功能连接较对照组减弱（均P〈0.05），与右侧额上回眶部、右侧额叶中、眶部、右侧额中回功能连接较对照组增强（均P〈0.05）；PCS组右侧杏仁核与双侧壳核、右侧额下回眶部、左侧岛叶、双侧楔前叶、双侧颞上极、右侧颞上回、右侧缘上回等功能连接较对照组减弱（P〈0.05），与左侧枕叶中部及左侧枕叶上部功能连接较对照组增强（P〈0.05）。 结论静息状态下PCS患者情绪网络功能的异常，可能是导致PCS患者情绪、认知等功能障碍的原因之一。

ObjectiveTo discuss functional connectivity changes in the emotional network of patients with post-concussion syndrome （PCS） and their clinical significance by resting-state functional magnetic resonance imaging （rs-fMRI）. MethodsTwenty-seven patients with PCS were recruited from the Department of Neurosurgery of Anhui provincial hospital affiliated to Anhui medical university from October 2015 to April 2016, and 27 healthy subjects were recruited as the controls. The Hamilton Anxiety Scale （HAMA） and The Hamilton Depression Scale （HAMD） were used to evaluate the emotional state of two groups of subjects. All fMRI data were preprocessed after RS-fMRI scanning, the left and right amygdala were selected as region of interest （ROI） to make functional connectivity （FC） calculation with the whole brain and then the results were did statistical analysis in order to obtain the altered brain areas of amygdala and whole brain functional connectivity in the PCS patient, to understand the functional changes of emotional network. ResultsHAMA and HAMD scores of PCS group and the health controls had significant statistical difference （HAMA： the PCS group 9.8±1.5, the health controls 4.5±1.2, P=0.044; HAMD： the PCS group 12±1.2, the health controls was 4.2±1.5, P=0.024）. Compared with the health controls, the left amygdala in PCS patients showed decreased FC with left insula, left putamen, left anterior cingulate gyrus, left inferior orbital frontal gyrus, left medial superior frontal gyrus, bilateral superior temporal gyrus, left superior temporal pole, bilateral supramarginal gyrus et al, on the contrary with the increased FC with right superior orbital frontal gyrus, right middle frontal lobe, right orbital frontal lobe, right middle frontal gyrus. The right amygdala in PCS patients showed decreased FC with bilateral putamen, right inferior orbital frontal gyrus, left insula, bilateral precuneus, bilateral superior temporal pole, right superior temporal gyrus, right supramarginal gyrus et al. Similarly, it had the increased FC with the left middle occipital lobe and the left superior occipital lobe. ConclusionAbnormal emotional network function of PCS patients in resting state, which may be one of the reasons that lead to emotional and cognitive dysfunction in PCS patients.