经颅磁电刺激治疗成人屈光参差性弱视的rs-fMRI机制研究

Study on the rs-fMRI Mechanism of Transcranial Magnetoelectric Stimulation Treatment for Adult Anisometropic Amblyopia

目的基于静息态功能磁共振成像(rs-fMRI)技术探讨经颅磁电刺激(TMS)干预对成人屈光参差性弱视患者关键脑区异常功能状态及损害特征的调控作用。方法纳入20例单(左)眼成人屈光参差性弱视患者,随机分为手术组[行后房型人工晶体(ICL)植入术]和TMS结合组(在手术组基础上进行TMS治疗),每组10例。两组患者在治疗前后均采用国际标准视力表检查视力以评价疗效。同时,两组患者分别在治疗前、治疗后进行1次rs-fMRI检查,采用局部一致性(ReHo)、低频振幅(ALFF)、比率低频振幅(fALFF)3种算法对获取的rs-fMRI图像进行脑区功能状态及响应特征分析。结果与治疗前相比,治疗后两组患者的裸眼视力均显著提高,且显著高于治疗前矫正视力(均P<0.05);治疗后两组相比,TMS结合组裸眼视力改善程度优于手术组(P<0.05)。手术组、TMS结合组治疗前后ReHo、fALFF值均无差异;与治疗前相比,手术组治疗后同侧额叶ALFF值升高,TMS结合组治疗后同侧小脑ALFF值降低;与手术组相比,TMS结合组治疗后同侧额叶、额上回ReHo值降低,对侧颞叶、颞上回ALFF值降低,对侧枕叶、楔叶fALFF升高(均P<0.05)。结论手术组和TMS结合组成人屈光参差性弱视患者的脑区自发活动改善效果显著。ICL植入术可能通过激活同侧额叶发挥作用;ICL植入术结合TMS治疗可能通过改善小脑功能,提高对侧枕叶、楔叶的兴奋性,调节枕叶相邻皮质及其他视觉相关皮质(同侧额叶及对侧颞叶)的神经元功能活动,纠正患者两眼间的兴奋性差异而发挥作用。

Objective To investigate the role of transcranial magnetic stimulation(TMS)in the modulation of abnormal functional status and damage characteristics of key brain regions in adult patients with anisometropic amblyopia via the resting-state functional magnetic resonance imaging(rs-fMRI)technique.Methods Single(left)eyes of 20 adult refractive amblyopia patients were included in this study and randomly divided into a surgical group[Implantable Collamer Lens(ICL)surgery]and a TMS combined group(TMS treatment on top of the surgical group),with 10 patients in each group.In both groups,the visual acuity of patients was examined before and after treatment via international standard visual acuity charts to evaluate the therapeutic effect.Moreover,patients in both groups underwent an fMRI examination once before and after treatment,and local coherence(ReHo),amplitude at low frequency(ALFF),and ratio amplitude at low frequency(fALFF)algorithms were used to characterize the functional state and response characteristics of the brain regions in the acquired fMRI images.Results Compared with that before treatment,the visual acuity of patients in both groups significantly improved after treatment and was significantly greater than the pretreatment corrected visual acuity(P<0.05).Compared with that in the two groups after treatment,the improvement in visual acuity in the TMS combined group was greater than that in the surgical group(P<0.05).There was no difference in the ReHo or fALFF values before and after treatment between the TMS combined group and surgical group.Compared with those before treatment,the ipsilateral frontal ALFF values were increased in the surgical group after treatment,and the ipsilateral cerebellar ALFF values were decreased in the TMS combined group.Compared with those in the surgical group,the ipsilateral frontal lobe and superior frontal gyrus ReHo values decreased,the contralateral temporal lobe and superior temporal gyrus ALFF values decreased,and the contralateral occipital lobe and cuneiform lobe fALFF values increased after treatment in the TMS combined group(all P<0.05).Conclusion The improvement in spontaneous brain activity in patients with anisometropic amblyopia in the surgical group and in the TMS combined group was significant.ICL implantation may act by activating the ipsilateral frontal lobe,ICL implantation in combination with TMS may act by improving cerebellar function,increasing the excitability of the contralateral occipital and cuneate lobes,modulating neuronal activity in the adjacent cortex of the occipital lobe and in the other visually related cortices(ipsilateral frontal and contralateral temporal lobes),and correcting the difference in excitability between the two eyes of the patients.and correcting the excitability differences between the patient's two eyes.