不同侧小脑梗死患者脑区比率低频振幅的改变及其与认知功能改变的关联

Changes of fractional amplitude of low frequency fluctuation and their correlation with cognitive function in patients with different side(left/right)cerebellar infarction

目的探讨不同侧小脑梗死患者头颅静息态磁共振成像中比率低频振幅(fALFF)值改变情况及其与患者认知功能改变的相关性。方法选择泰州市人民医院神经内科自2018年7月至2019年12月收治的22例急性左侧小脑后叶梗死患者(左侧小脑梗死组)、20例急性右侧小脑后叶梗死患者(右侧小脑梗死组),以及同期招募的22例性别、年龄、受教育年限等与2组患者相匹配的健康者(健康对照组),行头颅静息态功能磁共振成像检查、神经心理认知量表评估,分析小脑梗死患者脑区fALFF值改变特点以及其与患者认知功能改变的相关性。结果(1)与健康对照组相比,左侧小脑梗死组患者和右侧小脑梗死组患者的简易精神状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分、听觉词语学习测试(RAVLT)评分均明显降低,连线试验(TMT)耗时明显增加,差异均有统计学意义(P<0.05);右侧小脑梗死组患者的TMT耗时明显高于左侧小脑梗死组患者,差异有统计学意义(P<0.05)。(2)3组成员右侧扣带回、右侧额下回和左侧额上回部位的fALFF值差异有统计学意义(P<0.05,Alphasim校正)。与健康对照组相比,左侧小脑梗死组右侧额中回、右侧额下回和右侧扣带回的fALFF值明显增高,右侧小脑梗死组左侧海马的fALFF明显增加,差异均有统计学意义(P<0.05,Alphasim校正)。与右侧小脑梗死组相比,左侧小脑梗死组左侧额上回、左侧额下回和右侧额中回的fALFF值明显增高,差异均有统计学意义(P<0.05,Alphasim校正)。(3)左侧小脑梗死组患者右侧前额叶、右侧顶下小叶、右侧扣带回的fALFF值与其MoCA评分均呈负相关关系(P<0.05),右侧顶下小叶的fALFF值与其RAVLT评分呈负相关关系(P<0.05),右侧枕叶的fALFF值与其RAVLT评分呈正相关关系(P<0.05),右侧顶叶、右侧扣带回的fALFF值与其TMT耗时均呈正相关关系(P<0.05);右侧小脑梗死组患者右侧额叶的fALFF值与其MoCA评分呈正相关关系(P<0.05),右侧顶下小叶的fALFF值与其MoCA评分呈负相关关系(P<0.05),左侧前扣带回的fALFF值与其RAVLT评分呈正相关关系(P<0.05),左侧顶叶的fALFF值与其TMT耗时呈负相关关系(P<0.05)。结论小脑梗死患者存在认知障碍,单侧小脑梗死可引起对侧大脑半球关键脑区fALFF值代偿性增加,而异常改变的fALFF值与患者的认知障碍程度密切相关。

Objective To investigate the abnormal changes of fractional amplitude of low frequency fluctuation(fALFF)values in resting-state magnetic resonance imaging and their correlation with cognitive function in patients with different side(left/right)cerebellar infarction.Methods A total of 22 patients with acute left cerebellar infarction at the posterior lobe(left cerebellar infarction group)and 20 patients with acute right cerebellar infarction at the posterior lobe(right cerebellar infarction group),admitted to our hospital from July 2018 to December 2019,were enrolled;and 22 gender-,age and education level-matched healthy subjects(healthy control group)were chosen at the same time period.Head resting-state functional magnetic resonance imaging and neuropsychological cognitive scale were performed;the correlations between characteristics of fALFF changes and cognitive function changes of these patients were investigated.Results(1)As compared with the healthy control group,patients in the left cerebellar infarction group and right cerebellar infarction group had significantly lower scores of Mini Mental State Examination(MMSE),Montreal Cognitive Assessment(MoCA),and Rey auditory verbal learning test(RAVLT),and significantly longer Trail Making Test(TMT)time-consuming(P<0.05);the TMT time-consuming in right cerebellar infarction group was significantly longer than that in left cerebellar infarction group(P<0.05).(2)There were significant differences in fALFF values among the 3 groups in the right cingulate gyrus,right inferior frontal gyrus,and left superior frontal gyrus(P<0.05,Alphasim-revised).As compared with the healthy control group,the fALFF values in the right middle frontal gyrus,right inferior frontal gyrus and right cingulate gyrus of left cerebellar infarction group were significantly increased,and fALFF values in the right hippocampus of right cerebellar infarction group were significantly increased(P<0.05,Alphasim-revised).(3)In patients from left cerebellar infarction group,MoCA scores were negatively correlated with the fALFF values in the right frontal lobe,right inferior parietal lobule and right cingulate gyrus(P<0.05);RAVLT scores were negatively correlated with fALFF values in right inferior parietal lobule and positively correlated with fALFF values in occipital lobe(P<0.05);correlation analysis between fALFF values and TMT scores demonstrated a positive correlation in the right parietal lobe and right cingulate gyrus(P<0.05).In patients from right cerebellar infarction group,MoCA scores were positively correlated with the fALFF values in the right frontal lobe(P<0.05);MoCA scores were negatively correlated with the fALFF values in the right inferior parietal lobule(P<0.05);RAVLT scores were positively correlated with fALFF values in the left cingulate gyrus,and TMT time-consuming was negatively correlated with fALFF values in left parietal lobe(P<0.05).Conclusions Patients with cerebellar infarction have cognitive dysfunction.Unilateral cerebellar infarction can cause compensatory increase of fALFF values in key brain regions of the contralateral cerebral hemisphere.Abnormal fALFF changes are closely related to the degrees of cognitive dysfunction.