摘要
目的观察轻微型肝性脑病（MHE）患者的前后默认网络（DMN）内功能连接的改变，同时分析比较前后DMN的改变与神经认知损伤的关系。方法回顾分析2009年3月至2011年12月东南大学附属第二医院43例单纯肝硬化患者（noMHE，NMHE），32例MHE病患者以及21名健康对照的静息态功能磁共振（fMRI）数据，使用双回归法和通用的前后DMN模板来提取脑网络空间成分，各组进行单样本t检验，组间使用单因素方差分析（ANOVA），观察MHE患者的前后DMN功能连接改变，并和行为学参数进行相关性分析。结果通过单因素ANOVA分析（P〈0．01，AlphaSim矫正，clustersize〉40）发现：前DMN内，MHE组的功能连接较健康对照组和NMHE组在右侧额上回／双侧额内侧回中有显著的下降；而后DMN内，MHE组的功能连接则较另外两组在右侧颞上回／颞中回、左侧楔叶／双侧距状回内都显著上升。并且前后DMN的改变和神经认知功能损伤呈显著相关（P〈0．05）。结论本研究首次使用基于双回归模型的前后两种默认网络来考察MHE患者脑功能连接的改变，发现MHE患者前DMN中出现内源性功能组织损伤，而后DMN中则出现脑功能网络受损后的代偿性功能连接升高，这种升高表明MHE可能需要通过后DMN调用更多的认知资源来执行特定的活动。因此，基于双回归模型的前后DMN网络的改变可以成为研究MHE的潜在的神经影像学标志物。
Objective To investigate the functional connectivity （FC） impairments within anterior and posterior default mode networks （aDMN and pDMN） for cirrhosis with minimal hepatic encephalopathy （MHE）, and to analyze relationship between DMNs alterations with neurocognitive impairments. Methods From March 2009 to December 2011, a total of 43 cirrhotic patients without MHE （ NMHE groups）, 32 cirrhotic patients with current MHE （ MHE groups）, and 21 healthy controls were recruited in this study. All resting-state fMRI datasets were preprocessed and normalized into standard brain space. Two universal templates for aDMN and pDMN were applied to generate spatial patterns for aDMN and pDMN for each participate by dual regression. One sample t test were analyzed within groups, and one way ANOVA （ analysis of variance ） were performed to calculate the different FCs within aDMN and pDMN among groups. Additional correlation analysis was performed between difierent FCs within two DMNs and behavior scores. Results Within aDMN, FC of MHE patients were significantly deceased than controls and NMHE groups in right superior frontal gyrus （SFG）/bilateral medial frontal gyrus （MFG） ; while within pDMN, FC of MHE patients were significantly increased than controls and NMHE groups in right superior temporal gyms （STG）/middle temporal gyrus （MTG） and left cuneus/ bilateral calcarine gyri （one way ANOVA, P 〈 0. 01, cluster sizes 〉 40, AlphaSim correction）. The FC alterations in those region were significantly correlated with neurocognitive test scores （ Pearson correlation coefficient, P 〈 0. 05 ）. Conclusion Dual regression based aDMN and pDMN method was firstly applied to investigated functional connectivity impairments in MHE patients＇ brain. Functional deficits were endogenous within aDMN, while functional connectivity was compensatory enhancements within pDMN. These compensatory enhancements indicated that patients with current MHE had the potential to additionally recruit more neurological resource to accomplish the specific actions. Therefore, the alterations of dual regression based aDMN and pDMN can be potential neuroimaging biomarkers for MHE studies.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第5期334-338,共5页
National Medical Journal of China
基金
国家自然科学基金（81271739,81501453）
江苏省自然科学基金面上项目（BK20141342）
关键词
磁共振成像
肝性脑病
前默认网络
后默认网络
Magnetic resonance imaging
Hepatic encephalopathy
Anterior default mode network
Posterior default mode network
