脑卒中后认知功能障碍患者的功能性近红外脑网络特征分析

Functional Near-Infrared Brain Network Characteristics Analysis in Patients with Cognitive Impairment after Stroke

目的基于功能性近红外光谱技术(fNIRS)观察不同严重程度的脑卒中后认知功能障碍(PSCI)患者脑网络激活情况及功能连接差异。方法选择2020年4—11月复旦大学附属华山医院浦东院区康复科门诊及病房就诊的脑卒中患者40例,根据简易精神状态检查量表(MMSE)评分分为正常组14例、轻中度组11例、重度组15例。采用Fugl-Meyer运动功能评定量表(FMA)和功能综合评定量表(FCA)评估患者上、下肢运动功能;应用64通道fNIRS功能成像设备采集患者的静息态脑网络数据,并分析3组基于氧合血红蛋白(HbO2)和脱氧血红蛋白(HbR)的全脑功能连通性,以及背侧注意网络(DAN)、感觉运动网络(SEN)、腹侧注意网络(VAN)、额顶网络(FPN)、默认模式网络(DMN)、视觉网络(VIS)的同源脑网络功能连接强度和异源脑网络功能连接强度的差异。结果(1)运动功能:3组FMA、FCA运动功能评分差异均无统计学意义(P>0.05)。(2)全脑功能连通性及同源脑网络功能连接强度:3组基于HbO2、HbR的全脑功能连通性差异均无统计学意义(P>0.05)。与正常组比较,重度组基于HbO2的SEN区及FPN区同源脑网络功能连接强度差异有统计学意义(P<0.05);3组基于HbR的同源脑网络各感兴趣区间差异均无统计学意义(P>0.05)。(3)异源脑网络功能连接强度:与正常组比较,重度组SEN-VAN、SEN-DMN、SEN-FPN、VAN-FPN、DMN-FPN的异源脑网络功能连通强度均明显降低,差异均具有统计学意义(P<0.05);与轻中度组比较,重度组SEN-DAN、SEN-FPN的异源脑网络功能连通强度均明显降低,差异均具有统计学意义(P<0.05)。3组基于HbR的异源脑网络功能连接强度差异均无统计学意义(P>0.05)。(4)SEN-FPN异源脑网络功能连接与MMSE、FCA认知功能评分相关性分析:MMSE评分(r=0.32,P<0.05)和FCA评分(r=0.38,P<0.05)与SEN-FPN异源脑网络功能连接均呈正相关关系。结论SEN区和FPN区同源脑网络功能连接可能对脑卒中患者认知功能有重要作用;异源脑网络功能连接模式的改变可能与脑卒中后认知功能障碍的发生与进展密切相关;SEN-FPN功能连接强度变化可能是脑卒中患者认知功能下降的潜在影像学指标。

Objective To observe the differences in brain network activation and functional connectivity of patients with post-stroke cognitive impairment(PSCI)of different severity using functional near-infrared spectroscopy(fNIRS).Methods A total of 40 stroke patients in the outpatient and inpatient Rehabilitation Department in the Pudong District of Huashan Hospital,Fudan University from April to November 2020 were recruited and divided into normal group(n=14),mild to moderate group(n=11)and severe group(n=15)according to the mini-mental state examination(MMSE)score.Fugl-Meyer assessment scale(FMA)and functional comprehensive assessment(FCA)were used to evaluate the motor function of upper and lower limbs;64-channel fNIRS functional imaging device was used to collect the resting-state brain network data of patients.The whole brain functional connectivity was analyzed based on oxyhemoglobin(HbO2)and deoxyhemoglobin(HbR).Differences in functional connectivity strengths between homologous and heterologous brain networks in dorsal attention network(DAN),sensorimotor network(SEN),ventral attention network(VAN),frontoparietal network(FPN),default mode network(DMN)and visual network(VIS)regions were analyzed.Results(1)Motor function:there was no significant difference in FMA and FCA scores in three groups(P>0.05).(2)Whole brain functional connectivity and strength of homologous brain network functional connectivity:there was no significant difference in whole brain functional connectivity based on HbO2 and HbR in three groups(P>0.05).Compared with the normal group,there were significant differences in the strength of functional connectivity of the in the SEN and FPN regions of the HbO2-based homologous brain network in the severe group(P<0.05),but there were no significant differences in the regions of interest of the HbR-based homologous brain network in the three groups(P>0.05).(3)Functional connectivity strength of heterologous brain networks:compared with the normal group,the functional connectivity of SEN-VAN,SEN-DMN,SEN-FPN,VAN-FPN and DMN-FPN in the severe group decreased significantly,and the differences were statistically significant(P<0.05).Compared with the mild to moderate group,the functional connectivity of SEN-DAN and SEN-FPN in the severe group decreased significantly,and the differences were statistically significant(P<0.05).There was no significant difference of strength of functional connectivity based on HbR in the three groups(P>0.05).(4)Correlation analysis between SEN-FPN heterologous functional connectivity and MMSE,FCA scores:MMSE score(r=0.32,P<0.05)and FCA score(r=0.38,P<0.05)were positively correlated with SEN-FPN functional connectivity.Conclusion The SEN-FPN functional connectivity may play an important role in the cognitive function of stroke patients.Altered functional connectivity patterns of SEN-FPN may be closely related to the occurrence and progression of PSCI,and changes in functional connectivity strength of SEN-FPN may be a potential imaging indicator of PSCI.