不同病程耳鸣患者的静息态功能磁共振成像研究

Resting-State Functional Magnetic Resonance Imaging of Patients with Tinnitus of Different Durations

目的观察不同病程耳鸣患者静息态功能磁共振成像的中枢特征,以及其与临床特征之间的相关性,探讨可能存在的神经影像学机制及意义。方法选取我科2020年8月~2022年1月接诊的201例耳鸣患者(急性期100例,慢性期101例)以及同时期招募的100例健康志愿者作为对照组,采用低频振度(ALFF)方法计算三组间差异脑区,并提取ALFF值与患者临床特征进行相关性分析,此外计算差异脑区与全脑的功能连接(FC)。结果三组间差异脑区位于左侧枕上回、左侧楔叶、左侧前扣带回,事后分析显示,与健康对照组相比,急性期组的左侧枕上回、左侧楔叶ALFF值增加;慢性期组的左侧枕上回、左侧楔叶ALFF值增加,左侧前扣带回的ALFF值减少。相关性分析显示急、慢性组中,左侧前扣带回的ALFF值分别与THI量表评分呈正相关(r=0.663,P<0.001;r=0.696,P<0.001)。功能连接分析显示左侧楔叶与右侧楔叶功能连接增强;左侧前扣带回与左侧中央沟盖功能连接增强。结论急、慢性耳鸣患者存在多个脑区的功能连接强度异常,涉及视觉皮层、边缘系统等脑区,左侧前扣带回可能成为评估耳鸣严重程度的神经影像学标志物。

Objective To identify features of the central nervous system activities in relation to duration of tinnitus using resting-state functional magnetic resonance imaging,for potential correlation with clinical features and pathophysiological mechanisms and significances.Methods Study subjects included 100 patients with acute tinnitus,101 patients with chronic tinnitus(seen from August 2020 to January 2022)and 100 healthy volunteers(as the control group)were included in this study.The amplitude of low-frequency fluctuation(ALFF)was used to calculate brain regional activity differences among the three groups,and its correlation to clinical characteristics was analyzed.The whole braindifferential brain regions functional connectivity(FC)was also measured.Results Brain regions showing activity differences among the three groups included the left superior occipital gyrus,cuneus and anterior cingulate gyrus.Post hoc analysis showed that increased ALFF in the left superior occipital gyrus and the left cuneus in patients with acute tinnitus,and increased ALFF in the left superior occipital gyrus and cuneus are increased with decreased ALFF in the left anterior cingulate in those with chronic tinnitus,as compared to the control group.In the acute and chronic tinnitus,ALFF in the left anterior cingulate gyrus was positively correlated with the THI score(r=0.663,P<0.001 and r=0.696,P<0.001,respectively).Functional connectivity analysis showed enhanced FC between the left cuneus and the right cuneus.Conclusion Our study identified abnormal functional activities in multiple brain regions in patients with acute or chronic tinnitus,involving the visual system,limbic system and other brain networks.In addition,the left anterior cingulate may be a neuroimaging marker in assessment of tinnitus severity.