实时功能磁共振成像神经反馈调控伏隔核活性改善肥胖的影像学研究

Imaging study of real-time fMRI neurofeedback training based on the nucleus ambiguus to improve obesity

目的探究实时功能磁共振成像神经反馈(real-time functional magnetic resonance imaging neurofeedback,rtfMRI-NF)技术调控双侧伏隔核改善肥胖的作用。材料与方法招募2022年12月至2023年12月共24例肥胖患者作为研究对象。对肥胖受试者进行3周rtfMRI-NF训练干预,采集干预前后Barratt冲动性量表(Barratt Impulsiveness Scale Version 11,BIS-11)、三因素饮食问卷(Three-Factor Eating Questionnaire,TFEQ)中的非控制进食(Uncontrolled Eating,UE)、认知限制进食(Cognitive Rehabilitation,CR)、情绪性进食(Emotional Eating,EE)分量表、食物等级评分量表以及脑静息态功能磁共振成像(rest-state functional magnetic resonance imaging,rs-fMRI)数据。采用配对样本t检验比较受试者干预前后临床量表变化。使用SPM12软件对肥胖受试者rtfMRI-NF干预3周前后脑功能连接(functional connectivity,FC)值进行配对样本t检验分析,并分析干预前后FC值变化与临床量表评分的相关性。结果肥胖患者干预后BIS-11、TFEQ-UE、TFEQ-EE及食物等级评分下降,TFEQ-CR评分升高(P<0.05);肥胖受试者干预后左侧伏隔核与左侧颞中回的FC值减小,与左侧额中回的FC值增大(P<0.05,高斯随机场校正);右侧伏隔核与右侧小脑、右侧额下回的FC值增大,与左侧楔前叶的FC值减小(P<0.05,高斯随机场校正)。干预前后右侧伏隔核-右侧小脑8区的FC差值与TFEQ-UE评分改变呈负相关(r=−0.549,P=0.008),右侧伏隔核-左侧楔前叶的FC差值与BIS-11评分改变呈正相关(r=0.658,P<0.001)。结论rtfMRI-NF干预可能通过改变伏隔核与认知控制、注意力偏向和情绪记忆的分布式大脑区域FC,从而改善肥胖患者的不良饮食习惯。

Objective:Exploring the role of functional magnetic resonance imaging neurofeedback(rtfMRI-NF)to modulate bilateral nucleus ambiguus to improve obesity.Materials and Methods:A total of 24 obese patients from December 2022 to December 2023 were recruited as study subjects.A 3-week rtfMRI-NF training intervention was conducted on the obese subjects,the Barratt Impulsiveness Scale Version 11(BIS-11),three-factor eating questionnaire(TFEQ)with its three subscales:Uncontrolled Eating(UE),Cognitive Restriction(CR),and Emotional Eating(EE),the Food Grade Rating Scale,and resting-state functional magnetic resonance imaging datawere collected before and after the intervention.Paired-samples t-tests were used to compare changes in clinical scales before and after the subjects'intervention.Paired-sample t-tests were used to analyse the functional connectivity(FC)values of the obese subjects before and after the 3-week rtfMRI-NF intervention using SPM12 software.Pearson's correlation analysis was performed between the FC values of the statistically significant differences in brain regions and the scores of the clinical scales.Results:BIS-11,TFEQ-UE,TFEQ-EE,and food grade scores decreased and TFEQ-CR scores increased after the intervention in obese patients(P<0.05).FC values of the left nucleus ambiguus with the left middle temporal gyrus decreased and those with the left middle frontal gyrus increased after the intervention in obese subjects(P<0.05,GRF-corrected).FC values of the right nucleus ambiguus with the right cerebellum and the right inferior frontal gyrus increased and FC values with the left precuneus decreased(P<0.05,GRF corrected).FC values in the right nucleus ambiguus-right cerebellar area 8 were negatively correlated with TFEQ-UE scores after intervention(r=−0.549,P=0.008),and FC values in the right nucleus ambiguus-left precuneus were positively correlated with BIS-11 scores(r=0.658,P<0.001).Conclusions:The rtfMRI-NF intervention may ameliorate poor eating habits in obese patients by altering functional connectivity of the nucleus ambiguus with distributed brain regions of cognitive control,attentional bias,and emotional memory.