基于功能连接的方法探究失眠青少年大脑异常改变

Functional Connection-Based Approach to Explore Abnormal Brain Changes in Adolescents with Insomnia

目的基于功能磁共振成像(fMRI)的静息态功能连接(RSFC)方法观察失眠青少年结构异常脑区的功能连接。方法采集失眠青少年及健康对照各28例fMRI图像及睡眠状况自评量表(SRSS)、匹兹堡睡眠质量指数量表(PSQI)、失眠严重指数(ISI)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、蒙特利尔认知评估量表(MoCA),基于体素的形态学分析方法(VBM)探究大脑结构变化,基于RSFC分析大脑结构改变脑区与其他体素的功能连接(FC)值,对异常FC脑区与临床量表评分相关性进行分析。结果与健康对照组相比,青少年失眠组右侧楔前叶与左上顶叶、左侧中央前回、右侧颞中回FC增强(P<0.05,FDR校正);与右侧壳核及部分未定义脑区FC减弱(P<0.05,FDR校正);右侧楔前叶VBM体积与PSQI分数呈负相关(P=0.041);右侧楔前叶与右侧颞中回FC与SAS评分呈正相关(P=0.024);青少年失眠组MoCA量表评分显著降低,SRSS、PSQI、HAMA、HAMD评分较健康对照组显著增加,且差异有统计学意义。结论失眠青少年额叶、顶叶及楔前叶等多个脑区出现VBM、FC异常,可能与青少年产生焦虑抑郁等不良情绪、认知功能减低等症状有关。

Objective To observe the functional connections of the brain regions with structural abnormalities in adolescents with insomnia using the RSFC method based on functional magnetic resonance imaging(fMRI).Methods fMRI images,sleep status Self-rating Scale(SRSS),Pittsburgh Sleep Quality Index(PSQI),insomnia Severity Index(ISI),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)were collected from 28 insomnia adolescents and healthy controls,Montrealer Cognitive Assessment Scale(MoCA),voxel-based morphological analysis method(VBM)to explore brain structural changes,RSFC to analyze functional connectivity(FC)values between brain regions with altered brain structures and other voxels,and to analyze the correlation between abnormal FC brain regions and clinical scale scores.Results Compared with the healthy control group,FC was enhanced in the right anterior cuneiform lobe,left superior parietal lobe,left anterior central gyrus,and right middle temporal gyrus in the adolescent insomnia group(P<0.05,FDR correction).FC was weakened in the right putamen and some undefined brain areas(P<0.05,FDR correction);The VBM volume of the right anterior cuneate lobe was negatively correlated with the PSQI fraction(P=0.041).There was a positive correlation between FC and SAS scores in the right anterior cuneus and the right middle temporal gyrus(P=0.024).The score of the MoCA scale was significantly decreased in the adolescent insomnia group,and the scores of SRSS,PSQI,HAMA,and HAMD were significantly increased compared with the healthy control group,and the difference was statistically significant.Conclusion The abnormalities of VBM and FC in the frontal lobe,parietal lobe,and precuneus of insomnia in adolescents may be related to anxiety,depression and other adverse emotions,cognitive function reduction,and other symptoms.