意识障碍患者脑功能连接的改变特征及其对预后的评估作用

Altered Brain Network Connectivity in Patients with Disorders of Consciousness and its Assessment of Prognosis

目的分析颅脑外伤及非外伤病因导致的意识障碍患者脑和功能连接的改变特点,探讨评估患者意识水平和判断预后的生物学指标。方法搜集南京鼓楼医院神经外科2013年至2016年创伤性颅脑损伤（TBI）及其他病因伴意识障碍患者19例,同时招募正常志愿者14名作为对照组,进行脑结构和静息态功能磁共振成像（rsf MRI）检查。根据患者基线及随访时的格拉斯哥昏迷量表（GCS）评分,分析其意识水平与脑结构及功能连接指标的关系及其判断预后的作用。结果意识障碍患者（n=19）中,结构磁共振结果显示胼胝体、内侧前额叶及脑干的损伤概率较其他部位明显增高。静息态rs-f MRI成像结果显示,与正常对照组相比（n=14）,意识障碍患者的默认模式网络（DMN）和执行控制网络（ECN）的功能连接强度减低,并且ECN中左侧的颞下回及枕下回的功能连接强度与意识水平相关,DMN中楔前叶的功能连接强度与预后的GCS评分相关。与非TBI组相比,TBI组DMN功能连接减少,而ECN功能连接增多结论胼胝体、内侧前额叶及脑干的损伤导致意识障碍的可能性大,ECN及DMN的功能连接强度可作为评估患者意识水平和判断预后的临床指标。

Objective To investigate the alternation of brain functional connectivity in patients with disorders of consciousness due to traumatic brain injury and non-traumatic brain injury,and find biomarkers for consciousness level and recovery outcome. Methods Collecting Data of structural and functional MRI manifestations of 19 patients with disorders of consciousness,at Department of Neurosurgery,Nanjing Drum Tower Hospital,from 2013 to 2016,and 14 normal persons.We also collected Glasgow coma scale score of patients at baseline and three months later,analyzing the relationship between their MRI manifestations and level of consciousness in all patients,and functional connectivity strength of resting state networks and consciousness level and recovery outcome in patients with disorders of consciousness. Results There were 19 patients with disorders of consciousness,and their structural MRI results show the rate of lesions in corpus callosum,the medial prefrontal and brainstem is higher than other sites. From resting state functional MRI results,we found decreased Functional connectivity strength in Default mode network（ DMN） and Executive control network（ ECN） in patients with disorders of consciousness. The Functional connectivity strength of left inferior temporal and parietal cortex,which belong to the ECN were significantly correlated with consciousness level,and the Functional connectivity strength of precuneus,a part of DMN,was corrected with recovery outcome. Compared with patients with non-traumatic brain injury,patients with traumatic brain injury have higher functional connectivity strength of ECN and lower functional connectivity strength of DMN. Conclusion In conclusion,patients with lesions in corpus callosum,medial prefrontal cortex and brainstem easily resulted in unconsciousness. Our results also indicate that functional connectivity strengths of ECN and DMN may serve as indicators for consciousness level and recovery outcome in patients with disorders of consciousness.