先天性皮质性白内障弱视患儿自发脑活动的临床观察

Clinical observation of spontaneous brain activity in children with congenital cortical cataract amblyopia

目的探讨先天性皮质性白内障弱视患儿的自发脑活动特点。方法横断面研究。纳入2022年 1月至 2022 年12月于郑州大学第一附属医院就诊的20例单眼先天性皮质性白内障弱视患儿(单眼弱视组)和14例双眼先天性皮质性白内障弱视患儿(双眼弱视组),并招募年龄、性别相匹配的17名正常视力儿童(健康对照组)。所有受试者进行静息态功能性MRI成像检查,应用低频振荡幅度(ALFF)技术分析其自发脑活动。将每个体素的原始ALFF除以全脑平均ALFF进行标准化,得到标准化ALFF值(简称ALFF值),用来反映大脑不同脑区自发脑活动的强度。一般资料的比较采用单因素方差分析、Kruskal-Wallis检验和χ2检验;ALFF值的比较采用单因素方差分析。结果 3个组间年龄、性别、弱视眼或非主导眼分布及屈光参差度数的差异均无统计学意义(均P>0.05)。与健康对照组相比,单眼弱视组在右侧小脑后叶(体素67个,t=3.48)和左侧小脑后叶(体素71个,t=4.09)的ALFF值较高,在右侧中央后回(体素91个,t=-3.91)、右侧顶下小叶(体素73个,t=-4.88)、右侧额下回(体素78个,t=-4.09)、左侧顶下小叶(体素556个,t=-4.82)和左侧额下回(体素122个,t=-4.27)的ALFF值较低(均P<0.01);双眼弱视组在右侧岛叶(体素60个,t=3.54)、右侧罗兰岛盖部(体素69个,t=3.73)、右侧小脑后叶(体素54个,t=3.43)和左侧小脑后叶(体素143个,t=3.69)的ALFF值较高,在左侧额下回(体素99个,t=-4.39)、左侧中央后回(体素231个,t=-4.28)和右侧顶下小叶(体素54个,t=-3.77)的ALFF值较低(均P<0.01)。与单眼弱视组相比,双眼弱视组在左侧额中回(体素52个,t=3.15,P=0.029)、左侧小脑后叶(体素77个,t=3.39,P=0.001)和右侧罗兰岛盖部(体素53个,t=3.59,P=0.007)的ALFF值较高。结论先天性皮质性白内障弱视患儿存在多个脑区自发脑活动改变,且单、双眼弱视的自发脑活动变化存在差异。

Objective To investigate the characteristics of spontaneous brain activity in children with congenital cortical cataract amblyopia.Methods A cross-sectional study was conducted.Twenty cases of unilateral congenital cortical cataract amblyopia(unilateral amblyopia group)and 14 cases of bilateral congenital cortical cataract amblyopia(bilateral amblyopia group)were enrolled from January 2022 to December 2022 at the First Affiliated Hospital of Zhengzhou University.Seventeen age and gender matched children with normal visual acuity were recruited as the healthy control group.Resting-state functional MRI(fMRI)was performed on all participants,and the amplitude of low-frequency fluctuations(ALFF)technique was used to analyze their spontaneous brain activities.The original ALFF value of each voxel was divided by the average ALFF value of the whole brain to obtain the standardized ALFF value(referred to as ALFF value),which reflected the intensity of spontaneous brain activity in different brain regions.General demographic data were compared using one-way analysis of variance,Kruskal-Wallis test,and chi-square test.Comparison of ALFF values was conducted using one-way analysis of variance.Results There were no significant differences in age,gender,distribution of amblyopic eye or non-dominant eye,and degree of refractive error among the three groups(all P>0.05).Compared to the healthy control group,the unilateral amblyopia group showed higher ALFF values in the right posterior lobe of the cerebellum(67 voxels,t=3.48)and left posterior lobe of the cerebellum(71 voxels,t=4.09),and lower ALFF values in the right postcentral gyrus(91 voxels,t=-3.91),right inferior parietal lobule(73 voxels,t=-4.88),right inferior frontal gyrus(78 voxels,t=-4.09),left inferior parietal lobule(556 voxels,t=-4.82),and left inferior frontal gyrus(122 voxels,t=-4.27)(all P<0.01).The bilateral amblyopia group showed higher ALFF values in the right insula(60 voxels,t=3.54),right Rolandic operculum(69 voxels,t=3.73),right posterior lobe of the cerebellum(54 voxels,t=3.43),and left posterior lobe of the cerebellum(143 voxels,t=3.69),and lower ALFF values in the left inferior frontal gyrus(99 voxels,t=-4.39),left postcentral gyrus(231 voxels,t=-4.28),and right inferior parietal lobule(54 voxels,t=-3.77)(all P<0.01).Compared to the unilateral amblyopia group,the bilateral amblyopia group showed higher ALFF values in the left middle frontal gyrus(52 voxels,t=3.15,P=0.029),left posterior lobe of the cerebellum(77 voxels,t=3.39,P=0.001),and right Rolandic operculum(53 voxels,t=3.59,P=0.007).Conclusion Children with congenital cortical cataract amblyopia exhibit altered spontaneous brain activity in multiple brain regions,and there are differences in spontaneous brain activity changes between unilateral and bilateral amblyopia.