静息态fMRI技术观察肝性脑病患者双侧苍白球与全脑网络连接的改变研究

Connection changes between bilateral paleness and whole brain network in patients with hepatic encephalopathy by resting state fMRI scan

目的采用静息态功能MR(fMRI)技术探讨肝性脑病(HE)患者双侧苍白球与全脑网络连接的改变。方法 2015年2月～2017年6月诊治的明显HE患者(OHE)28例,轻微型HE患者(MHE)30例和选择健康人30例,受试者接受静息态fMRI扫描,选取双侧苍白球为种子点并进行全脑功能连接,分析比较各组双侧苍白球区域的脑功能网络连接差异。结果 HE患者苍白球与全脑网络连接出现差异的位置主要集中在额叶、顶叶和颞叶(P均<0.05),与健康人比,OHE患者右侧枕下回、右侧额中回、左侧眶部额上回等脑区连接减弱,而在左海马旁回、双侧尾状核、左三角部额下回连接增强;MHE患者左中央前回、左内侧额上回、双侧颞中回等脑区连接减弱;与MHE患者比,OHE患者右侧楔前叶、右侧颞中回、右梭状回、右侧角回连接减弱,而双侧尾状核和右侧颞下回连接增强(P均<0.05)。结论 HE患者双侧苍白球区域与多个脑区的功能连接受损,可能与临床出现的认知功能障碍有关。

Objectives To investigate the connection changes between bilateral paleness and whole brain network in patients with hepatic encephalopathy(HE).Methods 28 patients with overt HE(OHE),30 with minimal HE(MHE)and 30 healthy volunteers were recruited in our hospital between February 2015 and June 2017,and all of them received resting blood oxygenation level-dependent functional MRI(BOLD-fMRI)scan,and the bilateral globus pallidus was selected as the seed point and the whole brain function was connected.The functional MR data were analyzed to observe the differences among the brain functional network connections in the bilateral globus pallidus regions.Results The differences among the globus pallidus and the whole brain network in most patients with HE were located in the frontal,parietal and temporal lobes(P<0.05);the connection of the right side occipital gyrus,the right frontal gyrus and the left orbital frontal gyrus to the brain network in patients with OHE decreased,while the connection of the left central gyrus,the bilateral tail nucleus and the left triangle part increased as compared with in healthy persons;the connection of right wedge anterior lobe,right temporal gyrus,right fusiform gyrus,and right angle decreased,while the connection of bilateral tail nucleus and right temporal gyrus enhanced as compared with the patients with MHE(P<0.05).Conclusion The functional connections among the bilateral globus pallidus and multiple brain regions were impaired in the patients with HE and it is assumed that the cognitive dysfunctions in these patients might be related to the functional connection disorders.