摘要
目的：研究原发性失眠（PI）伴认知功能障碍患者静息态fMRI（rs-fMRI）局部一致性（ReHo）改变。方法2014年11月至2015年6月收集年龄、性别及受教育程度相匹配的PI伴认知功能障碍患者21例（患者组）和正常对照组25名，采用匹兹堡睡眠质量指数量表（PSQI）、蒙特利尔认知评估量表（MoCA）、简易精神状态检查量表（MMSE）、日常生活能力量表（ADL）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）对受试者睡眠情况及整体认知情况进行评估，利用两独立样本t检验比较两组神经心理学评分的差异。采用rs-fMRI分析受试者全脑静息态的ReHo，两组间比较采用独立样本t检验，并将两组间差异有统计学意义的脑区与神经心理学评分进行线性偏相关分析（以年龄、性别、受教育程度作为协变量）。结果与对照组相比，患者组PSQI评分显著增高，MoCA、MMSE评分显著降低，差异具有统计学意义（P〈0.05）。PI伴认知障碍患者组左侧颞叶中回（体素54个， t=3.14）、下回（体素76个，t=4.80），右侧颞叶下回（体素84个，t=4.30），左侧边缘叶海马旁回（体素301个，t=4.44）ReHo值增高（P值均〈0.05）；左侧颞叶上回（体素79个，t=－3.38），右侧颞叶梭状回（体素50个，t=－3.17）和颞上回（体素238个，t=－5.34），左侧额叶额下回（体素56个，t=－3.98），右侧边缘叶前扣带回（体素233个，t=－3.91），左侧顶叶角回（体素67个，t=－3.27）和顶上小叶（体素65个，t=－3.45）ReHo值减低（P值均〈0.05）。偏相关分析显示，左侧海马旁回局部ReHo值与PSQI评分呈正相关（r=0.771，P〈0.01），右侧前扣带回ReHo值与PSQI评分呈负相关（r=－0.649，P〈0.01）、与MoCA评分呈正相关（r=0.555，P〈0.05）。结论 PI伴认知功能障碍患者存在多处脑区ReHo改变，右侧扣带回的ReHo下降能反映睡眠障碍和认知功能下降程度，左侧海马旁回的ReHo升高可能与睡眠障碍脑功能代偿有关。
Objective To investigate the regional homogeneity （ReHo） changes of primary insomnia （PI） with cognitive impairment using resting-state fMRI. Methods Twenty-one patients with primary insomnia and cognitive impairment and 25 healthy volunteers matched with age, gender and education level were collected from Southwest Hospital of China from November 2014 to June 2015. Pittsburgh sleep quality index （PSQI）, Montreal Cognitive Assessment （MoCA）, Mini-mental State Examination （MMSE）, Activity of Daily Living Scale （ADL）, Hamilton depression scale （HAMD）, and Hamilton Anxiety Scale （HAMA） were conducted to evaluate the sleep and cognitive conditions of all subjects. Independent sample t-test was performed to evaluate the significant difference of neuropsychology scores of two groups. ReHo of rs-fMRI were evaluated and compared between two groups using independent sample T-test, meanwhile, the partial correlation analysis was conducted in ReHo values of different brain regions and neuropsychology scores （age, gender and education level were regarded as covariates）. Results Compared with normal controls, patients with primary insomnia and cognitive impairment showed significant higher PSQI score and lower MoCA and MMSE scores（P〈0.05）. The patient group also showed significant increased ReHo in the left medial temporal gyrus（54 voxels, t=3.14）, left inferior temporal gyrus（76 voxels, t=4.80）, right inferior temporal gyrus（84 voxels, t=4.30） and left parahippocampal gyrus（301 voxels, t=4.44） （P〈0.05） and decreased ReHo in the left superior temporal lobe（79 voxels, t=-3.38）, right fusiform gyrus（50 voxels, t=-3.17）, right superior temporal gyrus（283 voxels, t=-5.34）, right inferior frontal gyrus（56 voxels, t=-3.98）, right anterior cingulate（233 voxels, t=-3.91）, left parietal lobe angular gyrus（67 voxels, t=-3.27） and superior parietal lobule（65 voxels, t=-3.45） （P〈0.05）. The partial correlation analysis showed positive correlations between the ReHo values and PSQI scores of the left parahippocampal gyrus （R=0.771,P〈0.01）, negative correlations between the ReHo values and PSQI scores of the right anterior cingulate gyrus （R=-0.649,P〈0.01） and positive correlations between the ReHo values and MoCA scores of the right anterior cingulate gyrus（R=0.555,P〈0.05）. Conclusions Patients with primary insomnia and cognitive impairment have ReHo alterations in various brain regions. The decreasing ReHo in the right anterior cingulate gyrus can reflect the level of sleep disorder and cognitive impairment, and increasing ReHo in the left parahippocampal gyrus can reflect the compensation of sleep disorders of PI.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2016年第6期401-405,共5页
Chinese Journal of Radiology
关键词
入睡和睡眠障碍
磁共振成像
认知障碍
Sleep initiation and maintenance disorders
Magnetic resonance imaging
Cognition disorders
