先天性遗传性聋患者基于体素的脑形态学研究

Voxel-based morphometry study of the brain structures in patients with congenital hereditary hearing loss

目的利用基于体素形态学方法(voxel-based morphometry,VBM)探讨先天性遗传性聋(congenital hereditary hearing loss,CHHL)患者脑功能改变的生理基础。方法2016年6月至2017年6月,募集扬州市特殊教育学校的志愿者以及在江苏省苏北人民医院耳鼻咽喉科门诊就诊的CHHL患者作为病例组,共14例(男8例,女6例),平均年龄10~18(13.13±0.39)岁;同期募集在该科门诊就诊的无耳部疾病患者作为对照组,共23例(男10例,女13例),年龄10~18(13.50±0.49)岁。对所有受试者进行静态功能磁共振成像(functional magnetic resonance imaging,fMRI)全脑扫描,获得3D T1WI图像,经双样本t检验,在AlphaSim校正的P<0.001阈值水平,经相应分析软件处理,回顾性分析CHHL病例组与对照组的差异脑区。结果CHHL病例组全脑、灰质、白质及脑脊液体积与对照组比较差异均无统计学意义[(1397.53±103.98)cm3比(1439.45±128.84)cm3,(765.19±60.27)cm3比(800.139±77.64)cm3,(392.89±40.38)cm3比(414.54±49.22)cm3,(314.17±25.81)cm3比(296.47±51.42)cm3,P值均>0.05]。CHHL病例组的右颞极(颞中回)、右颞下回、左枕中回、右顶下小叶、左额中回、左枕上回、右额上回、左额上回的灰质体积高于对照组,差异具有统计学意义(P值均<0.001)。CHHL病例组的左海马旁回、右梭状回、右额中回、左颞下回、右枕中回、左脑岛、右额下回、左中央前回、右顶上小叶的灰质体积低于对照组,差异有统计学意义(P值均<0.001)。结论CHHL患者除存在听觉相关脑区结构的异常外,还存在广泛的与听觉相关脑区以外的皮层结构改变,提示CHHL患者全脑结构发生顺应性改变并发生功能重塑。

Objective To analyze the physiological basics for changes of cerebral functions in patients with congenital hereditary hearing loss(CHHL),by using voxel-based morphometry(VBM).Methods From June 2016 to June 2017,we recruited volunteers from Yangzhou Special Education School and CHHL patients from the Department of Otorhinolaryngology,Subei People′s Hospital as a case group with a total of 14 cases(8 males and 6 females),with an average age from 10 to 18(13.13±0.39).At the same time,patients with no ear diseases were recruited as a control group,a total of 23 cases(10 males and 13 females),with an average age from 10 to18(13.50±0.49).Brain scanning with resting state functional magnetic resonance imaging was performed on all subjects,and 3D T1WI was collected and processed by the analyzing software.Two sample t-tests were conducted with alphasim correction at the threshold level of P<0.001.Different morphologies of cerebral cortex were identified between patients with CHHL and their normal controls retrospectively.Results Compared to their normal controls,patients with CHHL had no significant difference in terms of brain volume,gray matter volume,white matter volume,and cerebrospinal fluid volume((1397.53±103.98)cm3vs.(1439.45±128.84)cm3,(765.19±60.27)cm3vs.(800.139±77.64)cm3,(392.89±40.38)cm3vs.(414.54±49.22)cm3,(314.17±25.81)cm3vs.(296.47±51.42)cm3,all P>0.05).However,compared to their normal controls,patients with CHHL had significantly increased(P<0.001)gray matter in the following cerebral gyri:right temporal pole:middle temporal gyrus,right inferior temporal gyrus,left middle occipital gyrus,right inferior parietal gyrus,and left middle frontal gyrus,left superior occipital gyrus,right superior frontal gyrus,and left superior frontal gyrus.Furthermore,compared to their normal controls,patients with CHHL had significantly decreased(P<0.001)gray matter in the following cerebral gyri:left parahippocampal gyrus,right fusiform gyrus,right middle frontal gyrus,left inferior temporal gyrus,right middle occipital gyrus,left insula,right inferior frontal gyrus,left precentral gyrus,and right superior parietal gyrus.Conclusions Patients with CHHL show global changes in cerebral cortex not limited to auditory associated cerebral areas.This suggests that adaptable reshaping of global brain structures and functions has occurred in patients with CHHL.