学龄期与青春期原发性单症状性夜遗尿症患儿静息态脑功能磁共振检查局部一致性研究

Regional homogeneity in school-age and adolescent children with primary monosymptomatic nocturnal enuresis using resting-state functional magnetic resonance imaging

目的采用静息态脑功能磁共振成像(resting-state cerebral functional magnetic resonance imaging,Rs-fMRI)技术,探讨学龄期及青春期原发性单症状性夜遗尿症(primary monosymptomatic nocturnal enuresis,PMNE)患儿脑功能局部一致性(regional homogeneity,ReHo)改变。方法采用前瞻性研究方法,纳入2017年6月至2020年1月就诊于郑州大学第一附属医院泌尿外科的PMNE患儿42例,按年龄分为学龄期(6~11岁)A组(n=22)和青春期(12~17岁)B组(n=20)。同期纳入健康学龄期儿童为C组(n=20)和健康青春期儿童为D组(n=20)作为对照组。采集所有被试者的Rs-fMRI图像,首先采用双因素方差分析疾病主效应、年龄主效应、疾病与年龄交互效应下的ReHo差异;然后进行事后检验比较,A组与C组、B组与D组脑功能特征上的差异。用疾病×年龄为固定因素的方差分析比较组内及组间年龄差异,对性别行χ^(2)检验。对4组被试者的ReHo脑图进行双因素方差分析(Two-way ANOVA)。采用双样本t检验进行事后检验分析学龄期、青春期PMNE患儿异常脑区的差异。结果双因素方差分析结果显示,疾病主效应脑区为左颞极的颞上回(MNI:x,y,z=-48,18,-9;F=-5.328)和左侧缘上回(MNI:x,y,z=-60,-36,39;F=-3.865)。年龄主效应脑区为右内侧和旁扣带脑回(MNI:x,y,z=6,-21,39;F=-4.911)及左辅助运动区(MNI:x,y,z=-3,-6,75;F=-3.863)。事后检验结果显示,A组与C组比较,ReHo升高的脑区为距状裂周围皮层(MNI:x,y,z=0,-69,21;F=4.675),降低的脑区为左小脑蚓部10区(MNI:x,y,z=-3,-42,-36;F=-4.860)。B组与D组比较,ReHo值降低的脑区为左颞极的颞上回(MNI:x,y,z=-54,0,0;F=-4.767)、左侧缘上回(MNI:x,y,z=-63,-36,33;F=-5.440)和右侧缘上回(MNI:x,y,z=60,-30,-30;F=-6.451)。结论学龄期PMNE患儿存在小脑、枕叶功能异常,青春期PMNE患儿存在颞叶、缘上回功能异常。这些异常脑区可能参与了不同年龄PMNE患儿遗尿的发生。

Objective To explore the change of regional homogeneity(ReHo)in school-age and adolescent children with primary monosymptomatic nocturnal enuresis(PMNE)using resting-state cerebral functional magnetic resonance imaging(Rs-fMRI).Methods Forty-two PMNE children admitted from June 2017 to January 2020 were recruited for this prospective study.They were divided into school-age(6-11 years)group A(n=22)and adolescent(12-17 years)group B(n=20).Group C(n=20)of healthy school-age children and group D(n=20)of healthy adolescent children were included as controls.Rs-fMRI images of all subjects were collected.Two-way ANOVA was utilized for examining the ReHo differences under the major effect of disease,major effect of age and interaction effect.Then post hoc tests were conducted for comparing the differences in brain functional characteristics between groups A and C and groups B and D.Results Two-way ANOVA revealed that the major affected brain region was superior temporal gyrus of left temporal pole(MNI:X,Y,Z=-48,18,-9;F=-5.328)and superior left margin gyrus(MNI:x,y,z=-60,-36,39;F=3.865).The major age-affected brain regions were right medial and paracingulate gyrus(MNI:X,Y,Z=6,-21,39;F=-4.911)and left auxiliary motor area(MNI:x,y,z=-3,-6,75;F=3.863).The results of post hoc examination showed that,as compared with group C,brain region of elevated Reho in group A was peripheral talar fissure cortex(MNI:x,y,z=0,-69,21;F=4.675)and decreased cerebral region was left vermis 10(MNI:X,Y,Z=-3,-42,-36;F=4.860).As compared with group D,brain region of reduced ReHo in group B was superior temporal gyrus of left temporal pole(MNI:X,Y,Z=-54,0,0;F=-4.767),superior left margin gyrus(MNI:x,y,z=-63,-36,33;F=5.440)and right superior margin gyrus(MNI:x,y,z=60,-30,-30;F=6.451).Conclusions Cerebellar and occipital lobe functional abnormalities are present in school-age PMNE children and temporal lobe and supramarginal gyrus functional abnormalities in adolescent children.These abnormal brain regions may be involved in voiding with PMNE at different ages.