抗N-甲基-D-天冬氨酸受体脑炎伴认知损伤患者的脑功能低频振幅及局部一致性的变化

Changes in brain function using regional homogeneity and amplitude of low-frequency fluctuation methods in patients with anti-N-methyl-D-aspartate receptor encephalitis with cognitive impairment

目的应用静息态功能磁共振(rs-fMRI)探究抗N-甲基-D-天冬氨酸受体脑炎伴认知损伤(ANMDARE-CI)患者脑功能低频振幅(ALFF)及局部一致性(ReHo)的改变。方法纳入33例抗N-甲基-D-天冬氨酸受体脑炎(ANMDARE)患者及18例对照受试者(Control组)实施rs-f MRI扫描、北京版蒙特利尔认知评估(MoCA-B)及神经心理量表。根据MoCA-B量表评估划分为认知损伤组(ANMDARE-CI组,n=17)及认知未损伤组(ANMDARE-CN组,n=16),采用ReHo及ALFF分析ANMDARE-CI组、ANMDARE-CN组及Control组3组间脑活动差异。采用SPM12进行单因素方差分析,提取差异脑区的ReHo和ALFF值进行独立样本t检验及ANMDARE患者临床资料和量表相关分析。结果相较ANMDARE-CN组和Control组,ANMDARE-CI组双侧小脑ALFF下降,右侧额上回、左侧中央前回ALFF升高(P<0.01);相较Control组,ANMDARE-CI组和ANMDARE-CN组双侧丘脑ALFF下降及右侧小脑前叶ReHo升高;ANMDARE-CN组左前扣带回ReHo值显著低于ANMDARE-CI组和Control组(P<0.01)。右侧额上回ALFF值升高与MoCA-B执行能力评分呈负相关(r=-0.586,P=0.013)。左侧中央前回ALFF升高与MoCA-B定向评分呈负相关(r=-0.668,P=0.003),与汉密尔顿焦虑评分(HAMA)呈正相关(r=0.665,P=0.004)。未发现ReHo与临床资料相关。结论ANMDARE-CI的脑功能异常可能与小脑自发性活动变化有关。

Objective To use resting-state functional magnetic resonance imaging(rs-fMRI)to study amplitude of low-frequency fluctuation(ALFF)and regional homogeneity(ReHo)changes in brain function in patients with anti-N-methyl-D-aspartate receptor encephalitis with cognitive impairment(ANMDARE-CI).Methods A total of 33 patients with anti-N-methyl-D-aspartate receptor encephalitis(ANMDARE)and 18 healthy volunteers(Controls)underwent rs-fMRI,the Beijing version of the Montreal Cognitive Assessment(MoCA-B)and neuropsychological scales.The cognitively impaired(ANMDARE-CI,n=17)and the cognitively normal(ANMDARE-CN,n=16)were divided according to the assessment of the MoCA-B scale.Differences in brain activity between the ANMDARE-CI,ANMDARE-CN and control were analysed using ReHo and ALFF.One-way ANOVA was performed using SPM12,ReHo and ALFF values for differential brain regions were extracted for independent samples t-tests for two-way comparisons and correlation analysis between clinical data and ANMDARE scales.Results Compared with ANMDARE-CN and Control,in ANMDARE-CI,ALFFs of bilateral cerebellar were reduced,and the right superior frontal gyrus and left central anterior gyrus ALFF were increased(P<0.01).Compared to Controls,in ANMDARE-CI and ANMDARE-CN,ALFFs of bilateral thalamus and ReHo of the right anterior cerebellar lobe were decreased(P<0.01).ReHo of Left Anterior Cingulate in ANMDARE-CN was significantly lower than ANMDARE-CI and Controls(P<0.01).Increased ALFF values on the right superior frontal gyrus were inversely correlated with MoCA-B performance scores(r=-0.586,P=0.013).Increased left central anterior gyrus ALFF was negatively correlated with the MoCA-B directional score(r=-0.668,P=0.003)and positively correlated with HAMA(r=0.665,P=0.004).No correlation between ReHo values and clinical data was found(P>0.016).Conclusions Abnormal brain function in ANMDARE_CI may be associated with altered spontaneous cerebellar activity.