肌萎缩侧索硬化患者丘脑局灶性损伤与认知功能障碍的相关性

Focal thalamus alterations and their associations with cognitive impairment in patients with amyotrophic lateral sclerosis

目的探讨肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)患者丘脑结构、功能改变及其与认知功能的相关性。方法采集78例ALS患者及49例健康对照者的3DT1结构像及静息态功能磁共振影像,采用顶点分析比较两组丘脑形态学差异;对功能磁共振图像以丘脑亚区为种子点进行全脑功能连接分析,并与认知量表评分进行偏相关分析。结果与对照组相比,顶点分析显示,ALS组双侧丘脑前额叶、颞叶亚区萎缩。功能连接分析中,患者组丘脑运动-感觉亚区与右侧运动区域,颞叶亚区与双侧枕外侧叶、楔前叶和右侧颞横回间功能连接增加;相比之下,丘脑颞叶亚区与扣带旁回、左侧背内侧前额叶及左侧尾状核间功能连接减低。偏相关分析显示,楔前叶、扣带旁回、左侧尾状核、左侧背内侧前额叶功能连接改变与多个认知量表相关。结论ALS患者丘脑结构及功能的选择性损伤在其认知功能障碍中有重要作用。

Objective To investigate changes in thalamus structure and function and their associations with cognitive impairment in patients with amyotrophic lateral sclerosis(ALS).Methods 3D high-resolution structural imaging and resting-state fMRI were applied in 78 ALS patients and 49 healthy volunteers.The shape of the thalamus was assessed using a vortex analysis and functional connectivity between the thalamus subregion and cortex was evaluated by a seed-based correlation analysis.Partial correlation analysis was used to evaluate the correlation between focal thalamus alterations and clinical assessments.Results Compared with the control group,vertex analysis showed significant atrophy in the prefrontal and temporal subregions of bilateral thalamus in the ALS group.Patients exhibited increased functional connectivity of motor-sensory ROI with the right motor cortex,of temporal ROI with the bilateral lateral occipital cortex,precuneus and right temporal subregion.In contrast,decreased function connectivity was found mainly between temporal ROI and paracingulate gyrus,left dorsomedial prefrontal lobe and left caudate.Partial correlation analysis showed that the functional connectivity of the precuneus,paracingulate cortex,left caudate nucleus and left prefrontal lobe was correlated with multiple cognitive performances.Conclusion Selective damage of thalamic structure and function in ALS plays an important role in cognitive and behavioral disorders.