原发性失眠患者奖赏网络关键核团在静息态fMRI功能连接的改变

Altered functional connectivity of key nuclei of the reward network in resting⁃state fMRI in patients with primary insomnia

目的:利用功能性磁共振成像(fMRI)技术观察原发性患者奖赏网络区域中脑腹侧被盖(Ventral ttegmental area,VTA)以及伏隔核(Nucleus accumbens,NAcc)脑功能连接的改变。方法:28例原发性失眠比较26例健康对照组脑功能成像的改变,并分析中脑腹侧被盖以及伏隔核功能连接的改变与失眠的情绪障碍障碍之间的关系。结果:比较原发性失眠患者对比健康对照组,VTA与NAcc全脑的功能连接均降低,与VTA-l功能连接增降低的脑区为双侧前扣带回、左侧眶额回,与VTA-r功能连接增降低的脑区为双侧前扣带回、左侧眶额回、右侧中央前回,与NAcc-l功能连接降低的脑区为双侧丘脑、辅助运动区,与NAcc-r功能连接降低的脑区为双侧丘脑、小脑。结论:睡眠障碍会显著降低奖赏网络中VTA与NAcc的功能连接,说明长期睡眠障碍可能影响在原发性失眠患者奖赏处理能力,导致失眠患者情感功能发生障碍。

Objective:To observe the alterations of brain functional connectivity in the Ventral ttegmental area(VTA)and the Nucleus accumbens(NAcc)in the reward network area of primary patients using functional magnetic resonance imaging(fM⁃RI).Methods:Twenty-eight patients with primary insomnia were compared with 26 healthy controls,and the relationship between altered functional connectivity in the Ventral Ttegmental Area(VTA)and the Nucleus Accumbens(NAcc)and mood disorders in insomnia was analysed.Results:Comparing primary insomnia patients with healthy controls,the functional connectivity of the VTA and NAcc was reduced in the whole brain.The brain regions with reduced functional connectivity of the VTA-l were bilater⁃al anterior cingulate gyrus and left orbitofrontal gyrus,the brain regions with reduced functional connectivity of the VTA-r were bi⁃lateral anterior cingulate gyrus,left orbitofrontal gyrus,and right precentral gyrus,and the brain regions with reduced functional connectivity of the NAcc-l were bilateral thalamus,supplementary motor area,and NAcc-r,and the brain regions with reduced functional connectivity were bilateral thalamus,supplementary motor area,and NAcc-r.The brain regions with reduced NAcc-r functional connectivity were bilateral thalamus and cerebellum.Conclusion:Sleep disorders significantly reduced the functional con⁃nectivity between VTA and NAcc in the reward network,suggesting that long-term sleep disorders may affect the reward process⁃ing ability of patients with primary insomnia and lead to emotional dysfunction in insomnia patients.