基于比率低频振幅的甲状腺功能亢进症患者脑功能研究

Spontaneous Brain Activities in Hyperthyroidism Patients Assessed Using Fractional Amplitude of Low-frequency Fluctuation

背景甲状腺功能亢进症(以下简称甲亢)是临床常见的内分泌心身疾病,常伴发负性情绪,严重影响患者预后,且甲亢患者自杀可能性为未患病者的5倍多。因此探讨甲亢患者脑损害的神经影像学特征有一定的临床价值和社会意义。目的通过静息态功能磁共振成像(rs-fMRI)分析甲亢患者脑自发活动异常模式,并探讨甲亢患者脑损害的神经影像学特征。方法选取2014年12月至2016年6月在新乡市中心医院门诊拟行^(131)I治疗的甲亢患者25例纳入甲亢组,同时选取医院和临近社区招募的性别、年龄、受教育程度与甲亢组无显著差异的健康志愿者28例作为对照组。使用症状自评量表(SCL-90)评估研究对象的心理健康状况。研究对象均接受rs-fMRI检查,通过测量全脑比率低频振幅(fALFF)反映局部脑自发活动。应用Pearson相关分析探讨平均比率低频振幅(mfALFF)值与临床变量及心理健康状况之间的关系。结果甲亢组SCL-90焦虑、敌对评分高于对照组(P<0.05)。与对照组相比,甲亢组右侧小脑蚓部7区〔蒙特利尔神经研究所(MNI)坐标:3、-75、-27,t=4.381〕、左侧丘脑(MNI坐标:-6、-6、0,t=3.545)、右侧丘脑(MNI坐标:6、-3、3,t=4.356)的mfALFF值升高,左侧小脑后叶(MNI坐标:-39、-81、-27,t=-3.402)、左侧眶部额中回(MNI坐标:-9、57、0,t=-5.253)、左侧额下回(MNI坐标:-42、33、18,t=-3.747)的mfALFF值降低。相关性分析结果显示,右侧小脑蚓部7区的mfALFF值与SCL-90焦虑(r=-0.419,P=0.037)、敌对(r=-0.402,P=0.046)评分呈负相关。结论右侧小脑蚓部脑自发活动异常可能是甲亢患者脑损害的重要影像学标志,可为甲亢患者负性情绪产生的神经病理机制提供影像学参考依据。

Background Hyperthyroidism is a common endocrine psychosomatic disease,which is often accompanied by negative emotions,seriously affecting the prognosis of patients.Moreover,it is associated with more than 5 times more higher risk of committing suicide.Therefore,it has certain clinical and social significance to explore the neuroimaging characteristics of brain damage in patients with hyperthyroidism.Objective To analyze the abnormal patterns of spontaneous brain activity measured by resting-state functional magnetic resonance imaging(rs-fMRI),and the neuroimaging characteristics of brain damage in patients with hyperthyroidism.Methods Participants were recruited from December 2014 to June 2016,including 25 hyperthyroidism outpatients with ^(131)I therapy from Xinxiang Central Hospital,and 28 sex-,age-,and education level-matched healthy volunteers from the same hospital and the community near the hospital.Symptom Checklist-90(SCL-90)was used to assess the mental health.rs-fMRI was performed to measure the fractional fractional amplitude of low-frequency fluctuation(fALFF)to reflect local spontaneous brain activity.Correlations of the mean fALFF(mfALFF)and with clinical variables and psychological symptoms were analyzed.Results Hyperthyroidism patients had higher mean scores of anxiety and anger-hostility than controls(P<0.05).Hyperthyroidism patients had higher mean mfALFF values in the right cerebellar vermis region 7(MNI:3,-75,-27;t=4.381),left thalamus(MNI:-6,-6,0;t=3.545),and right thalamus(MNI:6,-3,3;t=4.356),and lower mean mfALFF values in the left posterior cerebellar lobe(MNI:-39,-81,-27;t=-3.402),left orbital middle frontal gyrus(MNI:-9,57,0;t=-5.253)and left inferior frontal gyrus(MNI:-51,15,18;t=-3.747).Correlation analysis showed that the mfALFF value of right cerebellar vermis region 7 was negatively correlated with the score of anxiety(r=-0.419,P=0.037)or anger-hostility(r=-0.402,P=0.046).Conclusion The abnormal spontaneous activity in the right cerebellar vermis may be an important imaging marker of brain damage in hyperthyroidism,and may be imaging evidence for the studying of neuropathological mechanism of negative emotion in hyperthyroidism.