乳腺癌化疗脑局部一致性异常的静息态fMRI研究

Abnormal Regional Homogeneity in Breast Cancer Patients after Chemotherapy:A Resting-state Functional MRI Study

目的通过局部一致性(ReHO)来探讨乳腺癌患者化疗后长期认知功能水平及其与神经心理学量表和血液生化指标的相关性。方法选取29名化疗后的乳腺癌患者(C+)和28名未经化疗的同龄乳腺癌患者(C-)进行静息态功能磁共振检查、神经心理学量表测试和血液学检查。结果与C-组相比,C+组运动疲劳、认知疲劳、感知认知障碍、他人的评价、对生活质量的影响评分得分增高,感知认知能力得分降低,差异有统计学意义(P<0.05),提示C+组认知能力下降。C+组左内侧和旁扣带回SmReHO值降低,左侧颞极:颞中回、右侧颞上回、左侧中央后回、右侧补充运动区SmReHO值升高(体素水平FWE校正,P<0.01)。相关性分析显示C+组右侧颞上回SmReHO值与数字符号实验、对生活质量的影响评分呈正相关,左内侧和旁扣带回SmReHO值与感知认知能力呈负相关,右侧补充运动区、左侧中央后回SmReHO值与胆固醇水平呈负相关。结论乳腺癌化疗患者长期存在认知功能损伤和脑功能活动异常,ReHO改变可能是其病理基础。

Objective The aim of this study was to investigate the level of long-term cognitive function of patients with breast cancer more than 1 year after chemotherapy using regional homogeneity,and to explore its correlation with neuropsychological scales and blood biochemical indexes.Methods This study were enrolled a total of 29 patients with breast cancer after chemotherapy treatment and assigned to C+group.28 newly diagnosed patients with breast cancer after surgery without chemotherapy treatment were included and assigned to C-group.Both groups underwent resting-state fMRI,neuropsychological tests and blood examinations.Results Compared with C-group,the scores of the fatigue scale for motor(FSMCM),the fatigue scale for cognitive(FSMC-C),perceived cognitive impairments(CogPCI),comments for others(CogOth)and impact on quality of life(CogQOL)in C+group were significantly increased,and perceived cognitive abilities(CogPCA)decreased significantly.The differences were statistically significant(P<0.05),suggesting that the cognitive ability of C+group decreased.C+group showed decreased SmReHO in left medial and paracingulate gyri and increased SmReHO in left temporal pole:middle temporal gyrus,right superior temporal gyrus,left postcentral gyrus,right supplementary motor area(voxel FWE correction,P<0.01).In C+group,the SmReHO in right superior temporal gyrus was positively correlated with digital symbol test(DST)scores and CogQOL.The SmReHO in left medial and paracingulate gyri was negatively correlated with CogPCA.The SmReHO in left postcentral gyrus and right supplementary motor area was negatively correlated with cholesterol level.Conclusion These findings suggest that there are persistent chemotherapy-related cognitive impairment and brain abnormalities in patients with breast cancer undergoing chemotherapy for a long time,and ReHO changes may be the pathological basis.