基于独立成分分析重症肌无力患者的静息态默认网络的功能连接改变及其与认知障碍的相关性

Functional connectivity changes in resting state default networks and its correlation with cognitive impairment in patients with myasthenia gravis based on independent component analysis

目的研究重症肌无力(myasthenia gravis,MG)患者大脑默认网络(default mode network,DMN)功能连接的改变,以及DMN和认知功能的关系。方法前瞻性纳入2020年1月至2022年12月就诊于苏州大学附属第一医院神经内科的MG患者39例,另选取同期性别、年龄、受教育年限、种族与MG患者匹配的40名健康志愿者作为健康对照组。对所有受试者进行神经心理学测试、情绪评估及静息态磁共振功能扫描。采用独立成分分析技术评估受试者大脑DMN的功能连接变化。采用Spearman相关性分析MG患者差异脑区的DMN的功能连接值与认知功能的相关性。结果MG组整体认知功能〔简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评分〕、言语学习和记忆能力(Rey听觉词语学习测验、词语流畅性测试)、视空间功能(钟表测试)评分均较对照组降低(均P<0.01);在执行能力测试方面,MG组连线功能测试完成时间长于对照组(P<0.01);MG组汉密尔顿焦虑量表和汉密尔顿抑郁量表评分均高于对照组(P<0.01)。独立成分分析结果显示,MG患者的DMN内功能连接在左后扣带回比对照组减弱(P<0.05,经过FDR校正)。MG患者的DMN内左后扣带回功能连接值与MMSE评分、数字符号转换测验评分呈正相关(P<0.05),而与连线测验A和B时间呈负相关(P<0.05)。结论MG患者在整体认知功能、言语学习和记忆力、视空间功能和执行功能方面下降,在左后扣带回的DMN内功能连接减弱,差异脑区在DMN内功能连接值与认知评分存在相关性,提示MG患者的认知功能损害可能与中枢神经系统受累有关。

Objective To study the changes in brain default mode network(DMN)functional connectivity in patients with myasthenia gravis(MG),as well as the relationship between DMN and cognitive function.Methods Prospective inclusion of 39 MG patients who visited the Department of Neurology in the First Affiliated Hospital of Soochow University between January 2020 and December 2022.In addition,40 healthy volunteers matched with MG patients in terms of gender,age,education level,and race during the same period were selected as the healthy control group.We conducted neuropsychological tests,emotional assessments,and resting state magnetic resonance imaging functional scans on all participants.Independent component analysis techniques were used to evaluate the functional connectivity changes of the DMN in the subject's brain.Spearman correlation analysis was used to examine the correlation between the functional connectivity values of DMN in different brain regions and cognitive function in MG patients.Results The overall cognitive function(MMSE and MoCA scores),speech learning and memory abilities(Rey auditory verbal learning test,verbal fluency test),and visual spatial function(clock drawing test)scores of the MG group were significantly reduced compared to the control group(all P<0.01).In terms of execution ability testing,the completion time of the MG group's connectivity function test was longer than that of the control group(P<0.01).The Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD)score in the MG group were significantly higher than the control group(both P<0.01).Independent component analysis showed that the default functional connectivity within the left posterior cingulate gyrus in MG patients was weaker compared to the control group(P<0.05,after FDR correction).The default left posterior cingulate gyrus functional connectivity value in MG patients was positively correlated with MMSE score and symbol digit modalities test score(P<0.05),but negatively correlated with trail-making test-A and-B time(both P<0.05).Conclusions MG patients experience a decline in overall cognitive function,speech learning and memory,visual spatial function,and executive function.Functional connectivity within the DMN of the left posterior cingulate gyrus is weakened.There is a correlation between functional connectivity values in different brain regions within the DMN and cognitive scores,suggesting that cognitive impairment in MG patients may be related to central nervous system involvement.