实时功能磁共振成像的神经反馈技术调控失眠障碍患者杏仁核活性对失眠的改善作用

Role of real-time functional magnetic resonance imaging neurofeedback in treating insomnia disorder via regulating amygdala activity

目的观察失眠障碍(ID)患者杏仁核活性,探讨实时功能磁共振成像的神经反馈(rtfMRI-NF)技术调控ID患者杏仁核活性对失眠的改善作用。方法2020年6月—2022年12月河南省人民医院诊治ID患者32例,采用rtfMRI-NF技术调控左侧杏仁核活性,1次/周,连续3周。采集干预前、后静息态功能磁共振成像数据及临床量表[匹兹堡睡眠质量指数(PSQI)、失眠严重程度指数(ISI)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)]评分。采用脑功能局部一致性(ReHo)分析干预前、后脑功能活动,选取差异脑区。采用Pearson相关法分析干预后差异脑区ReHo值与HAMA、HAMD评分的相关性;以干预前后ReHo值差异脑区为种子点进行全脑体素功能连接(FC)分析,计算FC值。结果患者干预后PSQI、ISI、HAMA、HAMD评分[(11.81±3.40)、(14.81±6.16)、(16.56±11.52)、(17.22±7.21)分]均低于干预前[(14.25±3.11)、(18.09±5.52)、(20.94±11.58)、(20.91±8.42)分](t=3.652,P=0.001;t=3.479,P=0.002;t=2.739,P=0.010;t=3.539,P=0.001),右侧楔前叶ReHo值低于干预前(FWE校正,体素水平P<0.005,团块水平P<0.05);以右侧楔前叶为种子点,右侧颞中回、右侧回直肌、左侧眶内额上回FC值均低于干预前(GRF校正,体素水平P<0.005,团块水平P<0.05)。患者干预后右侧楔前叶ReHo值与HAMA、HAMD评分均呈负相关(r=-0.426,P=0.015;r=-0.424,P=0.016)。结论rtfMRI-NF技术调控左侧杏仁核活性可改善ID患者焦虑、抑郁情绪,重塑默认网络、边缘网络中与情绪、认知相关脑区功能,进而改善失眠。

Objective To observe the amygdala activity in patients with insomnia disorder(ID),and to explore the role of real-time functional magnetic resonance imaging neurofeedback(rtfMRI-NF)in treating insomnia by regulating the amygdala activity.Methods Thirty-eight ID patients were diagnosed and treated in Henan Provincial People's Hospital from June 2020 to December 2022.The rtfMRI-NF technique was used to regulate the activity of the left amygdala once a week for 3 consecutive weeks.The resting function MRI data and scores of clinical scales[Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index Scale(ISI),Hamilton Depression Scale(HAMD),and Hamilton Anxiety Scale(HAMA)]were collected before and after intervention.Regional homogeneity(ReHo)was used to analyze the brain functional activities before and after intervention,and the differential brain region was selected.The Pearson correlation method was used to assess the correlation between the ReHo value of the differential brain region after the intervention and the scores of HAMA and HAMD.Functional connectivity(FC)of the whole brain voxels was analyzed using the differential brain region as seed point,and the FC value was calculated.Results The scores of PSQI,ISI,HAMA and HAMD were lower after intervention(11.81±3.40,14.81±6.16,16.56±11.52,17.22±7.21)than those before intervention(14.25±3.11,18.09±5.52,20.94±11.58,20.91±8.42(t=3.652,P=0.001;t=3.479,P=0.002;t=2.739,P=0.010,t=3.539,P=0.001),and the ReHo value of the right precuneus was lower after intervention than that before intervention(FWE-adjusted,voxel level P<0.005,mass level P<0.05).With the right precuneus as the seed point,the FC values of the right middle temporal gyrus,right gyrus rectus and left supraorbital frontal gyrus were all lower than those before intervention(GRF-adjusted,voxel level P<0.005,mass level P<0.05).After intervention,the ReHo value of the right precuneus was negatively correlated with the scores of HAMA and HAMD(r=-0.426,P=0.015;r=-0.424,P=0.016).Conclusion rtfMRI-NF can relieve anxiety and depression by regulating left amygdala activity in ID patients,reshape the function of brain regions related to emotion and cognition in the default mode network and limbic network,so as to treat insomnia.