功能磁共振成像观察脑卒中患者大脑灰质皮层结构及白质纤维束连接的改变

Functional Magnetic Resonance Imaging(FMRI)Was Used to Observe the Changes of Gray Matter Cortex Structure and White Matter Fiber Bundle Connectivity in Stroke Patients

目的基于功能磁共振成像(fMRI)技术探讨脑卒中患者大脑灰质皮层结构及白质纤维束连接的改变以及与认知障碍的关系。方法选择2020年5月至2022年5月我院收治的112例脑卒中患者作为研究对象并纳入实验组,选同期于我院进行体检的108例健康人群作为对照组。另将脑卒中伴有认知障碍患者根据是否进行认知训练分为训练组(n=16)和未训练组(n=48)。比较实验组和对照组的一般资料、认知障碍测试评分、执行功能特征和脑白质纤维束FA值;对比训练组和未训练组患者海马的静息状态功能连接(FC)的变化情况;采用Pearson检验分析脑卒中患者大脑灰质皮层结构及白质纤维束连接与认知障碍相关性。结果实验组在糖尿病史、吸烟史、高血压史、心脏病史、高血脂症以及纤维蛋白原、葡萄糖、甘油三酯、总胆固醇和高密度脂蛋白含量方面均显著高于对照组(P<0.05);实验组的BI评分、MMSE评分、MoCA评分、BNT、DSST、RAVLT即刻记忆、RAVLT延迟回忆均显著低于对照组,神经受损NIHSS评分显著高于对照组(P<0.05);实验组的词语流畅性、数字广度顺向显著低于对照组,Stroop C、朝向一致目标RT、执行网络效率值、双朝向目标RT显著高于对照组(P<0.05);对比两组研究对象的脑白质纤维束FA值发现,实验组的扣带回海马部(L)、下纵束(R)、穹隆(L)的脑白质纤维束FA值显著低于对照组(P<0.05);fMRI扫描结果显示训练组患者左海马-右额下回、左海马-右额中回、右海马-左额中回、右海马-左额下回、右海马-左额上回、右海马-左顶叶FC明显增加(P<0.005);未训练组患者左海马-右枕中回、右海马-右小脑后叶、右海马-左颞上回的FC均明显降低(P<0.005);Pearson检验分析结果显示,扣带回海马部(L)、下级束(R)、穹隆(L)的脑白质纤维束FA值以及左海马-右额下回、左海马-右额中回、右海马-左额中回、右海马-左额下回、右海马-左额上回、右海马-左顶叶FC分别与认知障碍均呈明显正相关(P<0.05)。结论脑卒中患者的认知障碍与大脑灰质皮层结构及白质纤维束连接的改变有关,而fMRI技术能够有效检测出白质纤维束FA值和海马静息状态功能连接(FC)的变化,具有较高的应用价值。

Objective To investigate the changes of gray matter cortical structure and white matter fiber bundle connectivity in stroke patients based on functional magnetic resonance imaging(fMRI)and their relationship with cognitive impairment.Methods 112 stroke patients admitted to our hospital from May 2020 to May 2022 were selected as the subjects and included in the experimental group,and 108 healthy people who had physical examination in our hospital at the same period were selected as the control group.In addition,stroke patients with cognitive impairment were divided into training group(n=16)and non-training group(n=48)according to whether they received cognitive training or not.The general data,cognitive impairment test scores,executive function characteristics and FA values of white matter fiber tracts were compared between the experimental group and the control group.The changes of resting-state functional connectivity(FC)were compared between the training group and the non-training group.Pearson test was used to analyze the relationship between gray matter cortical structure,white matter fiber bundle connectivity and cognitive impairment in stroke patients.Results The content of diabetes,smoking history,hypertension,heart disease,hyperlipidemia and fibrinogen,glucose,triglycerides,total cholesterol and high-density lipoprotein in the experimental group were significantly higher than that of the control group(P<0.05);the BI score,MMSE score,MoCA score,BNT,DSST,RAVLT instant memory and RAVLT delayed memory were significantly lower than that of the control group,and the score of nerve damage NIHSS was significantly higher than that of the control group(P<0.05);the word fluency and digital breadth of the experimental group were significantly lower than that of the control group,and Stroop C,goal RT,execution network efficiency value and two-directional target RT were significantly higher than that of the control group(P<0.05);Compared with the FA values of the white matter fiber bundles of the two subjects,it was found that the FA value of the white matter fiber bundle of the hippocampus(L),lower longitudinal bundle(R)and dome(L)in the experimental group was significantly lower than that of the control group(P<0.05);the results of fMRI showed a significant increase in the left hippocampus-low right forehead,left hippocampus-right forehead gyrus,right hippocampus-left forehead gyrus,right hippocampus-low-left forehead gyrus,right hippocampus-left parietal lobe FC in the training group(P<0.005);The FC of the left hippocampus-right occipital gyrus,right hippocampus-right posterior cerebellar lobe,right hippocampus-left temporal gyrus were significantly reduced(P<0.005);Pearson test analysis results showed that the leuk matter fiber bundle FA value of the hippocampus(L),lower longitudinal bundle(R),dome(L)and FC values of left hippocampus-right forehead gyrus,left hippocampus-right middle forehead gyrus,right hippocampusleft middle frontal gyrus,right hippocampus-left inferior frontal gyrus,right hippocampus-left superior frontal gyrus and right hippocampus-left parietal lobe were positively correlated with cognitive impairment,respectively(P<0.05).Conclusion The cognitive impairment of stroke patients is related to the changes of gray matter cortical structure and white matter fiber bundle connectivity.fMRI can effectively detect the FA value of white matter fiber bundle and the changes of hippocampal resting-state functional connectivity(FC),which has high application value.