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创伤性颅脑损伤(traumatic brain injury,TBI)是当今世界一个重要的公共卫生问题,TBI的发生率约为5 000万人次/年[1]。TBI后,病人常常遗留有不同程度的神经功能障碍,给家庭和社会带来了沉重的负担[2]。其中,认知功能障碍(如注意障碍)是TBI病人伤后长期存在的后遗症之一。研究[3-5]表明,认知功能依赖于人脑中大规模分布式神经网络的集成运行,其中默认网络(default mode network, DMN)被认为是注意任务匹配的神经网络,DMN是一个大脑系统, 它包含一些功能联系紧密的脑区,如扣带回/前楔叶、顶下小叶,内侧前额叶及特定纤维束(胼胝体膝部、扣带束、额枕上束)。磁共振弥散张量成像技术(diffusion tensor imaging, DTI)是根据水分子移动观察和追踪脑白质纤维束的非侵入性检查方法[6-8]。本研究采用临床常用的DTI技术对TBI病人的白质纤维束进行评估,同时采用认知功能量表分析TBI病人的注意障碍。以期揭示TBI后神经纤维的断裂可造成DMN的变化,且急性期DMN的改变与TBI病人注意障碍具有一定的相关性,为TBI病人早期注意障碍的评估和检测提供客观依据。
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依据DMN所涉及的解剖部位选取感兴趣区域(见图 1A~3A)。使用Functool软件对DTI影像数据进行后处理,结果可见对应的感兴趣区纤维束的示踪成像(见图 1B~3B),同时产生ADC图及FA图(见图 1C~3C、1D~3D)。
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TBI后DMN脑区纤维束的受损情况,与对照组相比,TBI组病人个脑区的FA值均降低(P<0.01),TBI组病人gCC的ADC值升高(P<0.01),而Cing、SFOF的ADC值与对照组差异无统计学意义(P>0.05)(见表 1)。
分组 n FA ADC gCC Cing SFOF gCC Cing SFOF 对照组 30 0.56±0.06 0.50±0.04 0.50±0.08 0.68±0.10 0.71±0.10 0.82±0.13 TBI组 45 0.40±0.08 0.34±0.06 0.41±0.10 0.82±0.03 0.74±0.23 0.80±0.37 t — 9.78 15.22* 4.27 7.27* 0.78* 0.34* P — <0.01 <0.01 <0.01 <0.01 >0.05 >0.05 *示t′值 表 1 TBI后FA、ADC的变化(x±s)
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TBI病人的认知功能评估显示,TBI组病人VST各部分耗时数均明显延长(P<0.01)(见表 2)。TBI早期DMN相关脑区(gCC、Cing、SFOF)的影像学特征与注意障碍的关系显示,在TBI病人中,DMN中gCC、Cing、SFOF的FA值之和与VST各部分耗时总和呈负相关关系(P<0.05, R2=0.291)(见图 2A);SFOF的FA值变化与VST中C部分的耗时呈负相关关系(P<0.05, R2=0.396)(见图 2B~D)。
分组 n Stroop D Stroop W Stroop C 对照组 30 18.11±5.14 21.50±2.12 28.46±3.23 TBI组 45 24.01±2.131 26.69±3.12 40.23±7.332 t′ — 5.96 8.58 9.48 P — <0.01 <0.01 >0.05 表 2 TBI后VST评估病人的注意功能(x±s;s)
基于默认网络结构早期诊断创伤性颅脑损伤后注意障碍的临床研究
Clinical study of the early diagnosis of attention disorder after traumatic brain injury based on default mode network
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摘要:
目的分析创伤性颅脑损伤(TBI)病人急性期默认网络(DMN)的结构变化,探讨其在早期诊断TBI后注意障碍的应用价值。 方法纳入45例TBI病人作为TBI组,在急性期通过磁共振弥散张量成像技术评估DMN的结构完整性。在恢复期采用注意量表评估病人注意障碍。招募30名健康志愿者作为对照组。分析TBI病人磁共振相关参数,并与对照组进行比较,在此基础上,评估其与认知功能评分的相关性。 结果与对照组相比,TBI病人急性期DMN结构内的各向异性分数(FA)降低(P < 0.01),胼胝体膝部(gCC)的表观弥散系数图(P < 0.01)。在恢复期,TBI病人注意量表评分较对照组均明显延长(P < 0.01)。急性期TBI病人DMN结构的变化与恢复期注意量表的评分显示,TBI病人DMN中扣带束、gCC、额枕上束(SFOF)的FA值之和与Stroop色词量表Victoria版本各部分耗时总和呈负相关关系(P < 0.05,R2=0.291);SFOF的FA值变化与VST中C部分的耗时呈负相关关系(P < 0.05,R2=0.396)。 结论TBI引起纤维连接的中断是损伤后DMN结构破坏的主要因素,DMN结构的破坏可作为早期诊断TBI后注意障碍依据。 Abstract:ObjectiveTo analyze the structural changes of default mode network(DMN) in patients with traumatic brain injury(TBI) in the acute phase, and explore the application value of DMN in the early diagnosis of attention disorder after TBI. MethodsForty-five patients with TBI were set as the TBI group, the structural integrity of DMN was evaluated using diffusion tensor imaging(DTI) during the acute phase, and the attention scale was used to evaluate the patient's attention disorder during convalescence.Thirty healthy volunteers were set as the control group.The MRI-related parameters of TBI patients were analyzed, and compared with the control group.The correlation between the parameters of DTI and cognitive function score was explored. ResultsCompared with the control group, the fractional anisotropy(FA) of brain region decreased(P < 0.01), and the apparent diffusion coefficient(ADC) of genitals of corpus callosum(gCC) increased in the acute phase(P < 0.01).In the convalescence period, the scores of attention scale in TBI patients were significantly longer than those in control group(P < 0.01).The results of the scores of DMN structure changes in the acute phase and scores of convalescence attention scale in the TBI patients showed that the sum of FA value of Cing, gCC and superior occipitofrontal fascicle(SFOF) were negatively correlated with the sumup time of each part of Stroop colour word scale Victoria version(P < 0.05, R2=0.291), and the FA value of SFOF was negatively correlated with the time of part C in VST(P < 0.05, R2=0.396). ConclusionsThe interruption of fiber connection in TBI patients is the key factor of damage of DMN structure.The damage of DMN structure can be used as a useful marker for the early diagnosis of attention disorder. -
Key words:
- traumatic brain injury /
- default mode network /
- attention disorder /
- early diagnosis
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表 1 TBI后FA、ADC的变化(x±s)
分组 n FA ADC gCC Cing SFOF gCC Cing SFOF 对照组 30 0.56±0.06 0.50±0.04 0.50±0.08 0.68±0.10 0.71±0.10 0.82±0.13 TBI组 45 0.40±0.08 0.34±0.06 0.41±0.10 0.82±0.03 0.74±0.23 0.80±0.37 t — 9.78 15.22* 4.27 7.27* 0.78* 0.34* P — <0.01 <0.01 <0.01 <0.01 >0.05 >0.05 *示t′值 表 2 TBI后VST评估病人的注意功能(x±s;s)
分组 n Stroop D Stroop W Stroop C 对照组 30 18.11±5.14 21.50±2.12 28.46±3.23 TBI组 45 24.01±2.131 26.69±3.12 40.23±7.332 t′ — 5.96 8.58 9.48 P — <0.01 <0.01 >0.05 -
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