乳腺癌患者新辅助化疗后静息态脑功能活动变化的短期纵向研究

Changes of resting-state brain functional activities in breast cancer patients after neoadjuvant chemotherapy:a short-term longitudinal study

目的本研究旨在探索初诊乳腺癌患者新辅助化疗(neoadjuvant chemotherapy,NAC)1周期后脑的自发性和同步性功能活动的短期纵向变化。材料与方法本研究共纳入36名行NAC的乳腺癌患者,分别于行NAC前(timepoint 0,TP0)和行NAC第1周期后(timepoint 1,TP1)进行静息态功能磁共振成像(resting-state functional MRI,rs-fMRI)扫描和神经心理测试。低频振幅(amplitude of low-frequency fluctuations,ALFF)和基于种子点的功能连接(functional connectivity,FC)分析用于评估所有被试的自发性和同步性脑活动,采用配对样本t检验进行纵向比较,并对rs-fMRI参数与神经心理测试评分进行相关性分析。结果与TP0相比,乳腺癌患者在TP1的焦虑自评量表(Self-Rating Anxiety Scale,SAS)评分显著下降(P<0.05),其余神经心理测试评分在两次评估之间差异无统计学意义;TP1的右侧额中回、右侧岛叶及左侧背外侧额上回的ALFF值显著降低(体素水平P<0.001,簇水平P<0.05),其中左侧背外侧额上回与右侧额中回之间的FC在TP1显著增高(体素水平P<0.005,簇水平P<0.05)。此外,左侧背外侧额上回在TP0的ALFF值与抑郁自评量表(Self-Rating Depression Scale,SDS)评分在TP0和TP1间的差值呈显著正相关(ρ=0.429,P=0.016);TP0和TP1之间左侧背外侧额上回与右侧额中回之间功能连接z值的差值与TP0和TP1之间连线测试A型(trail making test A,TMT-A)耗时差值呈显著正相关(ρ=0.443,P=0.012)。结论NAC在早期可能影响乳腺癌患者的脑自发性及同步性脑功能活动,涉及执行功能以及情绪调控等相关脑区。

Objective:To explore the short-term longitudinal changes of spontaneous and synchronous brain functional activity in newly diagnosed breast cancer patients after the first cycle of neoadjuvant chemotherapy(NAC).Materials and Methods:A total of thirty-six breast cancer patients with NAC were enrolled.Resting state functional magnetic resonance imaging(rs-fMRI)and neuropsychological tests were performed at the baseline before NAC(timepoint 0,TP0)and after the first cycle of NAC(time point 1,TP1).Amplitude of low-frequency fluctuations(ALFF)and seed-based functional connectivity(FC)analysis were conducted to assess intrinsic brain activity in all participants.Paired sample t test was used for longitudinal comparison,and the correlation between rs-fMRI parameters and neuropsychological test scores was analyzed.Results:Compared with TP0,the Self-Rating Anxiety Scale(SAS)scores of breast cancer patient at TP1 was significantly decreased(P<0.05),and the scores of other neuropsychological tests were not significantly different between the two timepoints.The ALFF values of the right middle frontal gyrus,the right insula and the left dorsolateral superior frontal gyrus at TP1 were significantly decreased(voxel level P<0.001,cluster level P<0.05),and the FC between left dorsolateral frontal gyrus and the right middle frontal gyrus were significantly increased at TP1(voxel level P<0.005,cluster level P<0.05).In addition,the ALFF value of the left dorsolateral frontal gyrus at TP0 was significantly positively correlated with the difference between TP0 and TP1 in the Self-Rating Depression Scale(SDS)score(ρ=0.429,P=0.016).The difference in FC z value between the left dorsolateral frontal gyrus and the right middle frontal gyrus between TP0 and TP1 was significantly positively correlated with the difference in trail making test A(TMT-A)time cost between TP0 and TP1(ρ=0.443,P=0.012).Conclusions:NAC may affect spontaneous and synchronous brain function activity immediately in breast cancer patients,involving executive function and emotion-related brain regions.