基于静息态fMRI影像学研究轻微肝性脑病患者双侧楔前叶与全脑连接的变化

Study on changes of brain functional connectivity of bilateral precuneus and other brain regions in patients with minimal hepatic encephalopathy based on resting-state fMRI

目的通过静息态fMRI影像学研究轻微肝性脑病患者双侧楔前叶与全脑其他区域连接的变化。方法选取2016年5月~2019年3月我院收治的肝性脑病患者作为观察组(n=95),另选择同期来院体检健康者作为对照组(n=95)。采用fMRI扫描仪对两组脑部进行扫描成像。通过种子体素相关性脑功能分析方法,分析处理图像,观察双侧楔前叶与其他脑区连接变化。观察两组血氨水平、数字连接试验及数字符号实验结果。采用spearman相关分析法分析观察组连接强弱存在差异的脑区与患者血氨水平、数字连接试验及数字符号实验结果的相关性。结果观察组血氨水平、数字连接试验结果高于对照组,数字符号实验结果低于对照组(P<0.05)。观察组左侧楔前叶与左侧顶下小叶、右侧额上回、左侧岛叶、左侧中扣带回的连接强度比对照组低,与左侧额上回连接强度比对照组高(P<0.05)。观察组右侧楔前叶与右侧缘上回、右侧颞极、双侧前额叶、内侧扣带回及左侧颞上回的连接强度比对照组低,与左侧后扣带回的连接强度比对照组高(P<0.05)。结论大脑双侧楔前叶与其他脑区连接能力在轻微肝性脑病患者中会出现部分降低或升高情况,左右侧楔前叶与其他脑区连接异常情况不完全相同。此变化可能是轻微肝性脑病神经损伤机制之一。

Objective To investigate the changes of brain functional connectivity of bilateral precuneus and other brain regions in patients with minimal hepatic encephalopathy based on resting-state fMRI.Methods 95 patients with hepatic encephalopathy(observation group)and 95 cases of physical examinees(control group)in our hospital from May 2016 to March 2019 were selected.All the selected subjects underwent fMRI.The changes of functional connectivity of bilateral precuneus and other brain regions were observed.The blood ammonia level,number connection test(NCT)and digit symbol test(DS)results were observed,and their correlation with disrupted functional connectivity was determined by spearman correlation analysis.Results The blood ammonia level and digital connection test results of the observation group were higher than those of the control group,and the digit symbol test results were lower than the control group(P<0.05).The brain functional connectivity of left precuneus with left inferior parietal lobule,right superior frontal gyrus,left insula,and left middle cingulate gyrus in the observation group was lower than those of the control group,while the brain functional connectivity of left precuneus with left superior frontal gyrus was higher than that of the control group(P<0.05).The brain functional connectivity of right precuneus with right supramarginal gyrus,right temporal pole,bilateral frontal lobe,medial cingulum cortex and left superior temporal gyrus in the observation group was lower than those of the control group,while the brain functional connectivity of right precuneus with left posterior cingulate gyrus was higher than that of the control group(P<0.05).Conclusion Abnormal resting-state functional connectivity of bilateral precuneus and multiple brain regions are demonstrated in patients with minimal hepatic encephalopathy,which may be the mechanism of endogenous neurological impairment of minimal hepatic encephalopathy.