车祸后急性应激反应患者脑结构网络拓扑学性质的变化

The altered topology of brain structural, network in patients with acute stress response after traffic accident

目的采用基于图论的复杂网络分析方法探讨车祸创伤幸存者在1周内急性应激状态下脑结构网络拓扑性质的改变，为患者及时、早期干预提供客观影像学参考。方法收集2013年1月至2016年2月收治于南京总医院的急性应激状态（急性应激障碍访谈问卷评分〉3分）车祸创伤患者20例及20名健康志愿者（健康对照）行3T弥散张量成像扫描，观察急性应激反应（ASrt）组和健康对照组全脑结构网络属性和节点属性的差异，进一步将汉密尔顿焦虑及抑郁量表评分共同作为协变回归后比较两组被试各参数间的差异，此外，计算结构网络属性异常脑区的相应参数和临床量表间的相关性。结果（1）ASR组和健康对照组均表现出了明显的小世界属性；（2）ASR组部分节点的节点属性改变明显，与健康对照组相比左侧额下回三角部的节点连接强度或（1．36±0．47比0．92±0．38。P=0．008）及节点中介中心性BCi（20±15比7±6，P=0．002）增高、右侧额下回眶部的Si（1．10±0．31比0．77±0．30，P=0．004）增高，而左侧尾状核的Si（0．75±0．24比1．04±0．35，P=0．004）降低；（3）进一步将焦虑和抑郁评分作协变量进行统计分析，左侧额下回三角部、尾状核、丘脑以及颞下回原有节点属性差异消失。结论本研究发现ASR患者脑结构网络的节点属性相对于健康对照出现了较明显的改变，主要异常位于前额叶及纹状体区，且这些改变部分与患者的焦虑和抑郁程度有关。

Objective To explore the changes of brain activities in traffic accident survivors with acute stress response （ASR） within a week by using complex networks analysis method based on graph- theory, and to find out the alteration of topological properties in structural brain network. Method From January, 2013 to February, 2016, twenty traffic accidents survivors with acute stress disorders （Acute Stress Disorder Interview, ASDI 〉 3 ）and twenty healthy controls underwent the 3T diffusion tensor imaging （DTI） magnetic resonance imaging scan in Nanjing General Hospital. The graph-theory analysis method was used to compare the structural brain network properties and nodal features between ASR survivors and controls. Statistical analyses were also performed by including anxiety and depression as covariates to evaluate their effect. In additional, Pearson correlation was performed between abnormal parametric values and clinical indices. Results （1） The brain structural networks had small-world properties in both groups; （2） while compared with healthy controls, patients with ASR showed increased weighted connectivity strength （Si, 1.36 ± 0. 47 vs 0.92 ±0. 38, P = 0. 008 ） and nodal hetweenness centrality （ BCi, 20 ± 15 vs 7 ＋ 6, P = 0. 002 ） in left triangular part of inferior frontal （IFG trlang_L）, increased Si in orbital part of inferior frontalgyrus （ 1.10 ±0. 31 vs 0. 77 ±0. 30, P =0. 004） and obviously decreased Si in left caudate （0. 75 ±0. 24 vs 1.04 ±0. 35, P =0. 004） ; （3） furthermore, the inclusion of anxiety and depression as eovariates abolished nodal parameters differences in IFG triang_ L, left caudate, thalamus and inferior temporal gyms. Conclusions The brain structure network in ASR patients has small world properties. But nodal parameters change obviously in some nodes compared with healthy controls and mainly locate in prefrontal lobe and striatum. High levels of anxiety and depression in ASR patients may partly account for these alterations.