基于静息态功能磁共振成像探讨卒中后疲劳的中枢机制

doi:10.3969/j.issn.1004-583X.2024.05.003

摘要/Abstract

摘要：

目的应用静息态功能磁共振成像探讨卒中后疲劳 (post-stroke fatigue, PSF)的中枢机制。方法随机选取2019年4月至2021年9月就诊于河北医科大学第二医院的急性脑梗死患者,分别在脑梗死急性期(发病14天内)和慢性期(发病3个月后)对被试者进行疲劳严重程度量表评估及功能磁共振成像检查,根据疲劳程度分组,应用MATLAB R2013b软件对数据进行处理,分析两组间小世界属性特征值γ、λ、σ、Cp、Lp和全脑静态功能网络连接(static functional network connectivity, sFNC)的差异,并将差异脑区与临床资料进行相关性分析。结果脑梗死急性期和慢性期两组性别、年龄差异均无统计学意义(P>0.05);两组脑网络均具有小世界属性(σ>1,γ>1,λ≈1),其中慢性期PSF组λ和Cp的曲线下面积较NPSF组减小,差异均有统计学意义(P<0.05),其余特征性参数曲线下面积差异均无统计学意义(P>0.05);梗死急性期PSF组与NPSF组相比,左侧额顶网络与视觉网络(visual network,VN)等多个网络的sFNC减低(P<0.05),双侧额顶网络分别与默认模式网络及感觉运动网络间的sFNC增高(P<0.05)。慢性期,与NPSF组相比,PSF组右侧额顶网络VN的sFNC减低(P<0.05),认知网络如默认模式网络与其他多个网络间sFNC增高(P<0.05)。结论脑梗死急性期PSF的发生可能与认知功能异常相关;脑梗死慢性期PSF患者部分脑网络间sFNC增强可能导致认知功能障碍,推测RFPN-VN的sFNC减低是高级执行网络功能过强而产生的抑制性代偿作用。

关键词: 脑梗死, 卒中后疲劳, 静息态功能磁共振成像, 小世界属性, 静息态功能网络连接

Abstract:

Objective To explore the central mechanism for post-stroke fatigue (PSF) by using resting-state functional magnetic resonance imaging. Methods Patients with acute cerebral infarction who were admitted to the Second Hospital of Hebei Medical University from April 2019 to September 2021 were randomly enrolled. Fatigue severity scale assessment and functional magnetic resonance imaging examination were performed on the subjects in the acute phase of cerebral infarction (within 14 days of onset) and chronic phase (3 months after onset). The subjects were grouped according to the fatigue degree, and the data were processed by MATLAB R2013b software. The differences in eigenvalues γ, λ, σ, Cp, Lp of small-world attribute and whole-brain static functional network connectivity (sFNC) between groups were analyzed, and the correlation between the different brain regions and clinical data was analyzed. Results There was no significant difference in gender and age between the PSF group and the non-fatigue (NPSF) group in the acute and chronic stages of cerebral infarction (P>0.05). The brain networks of the subjects in the both groups had small-world properties (σ>1, γ>1, λ≈1), the area under the curve of λ and Cp in the PSF group in the chronic phase was significantly reduced than that of the NPSF group (P<0.05), and there was no significant difference in area under the curve of other characteristic parameters(P>0.05). Compared with the NPSF group, sFNC of the left fronto-parietal network, visual network (VN) and other networks were significantly decreased in the PSF group at the acute stage of infarction (P<0.05). Left and right fronto-parietal network showed significantly increased sFNC (P<0.05) in the default mode network and sensory-motor network, respectively. Compared with the NPSF group, the sFNC of right fronto-parietal network-VN was significantly decreased in the chronic PSF group (P<0.05), and the sFNC in default mode network and other networks was increased (P<0.05). Conclusion The occurrence of PSF in acute stage of cerebral infarction may be related to cognitive dysfunction. The increase of sFNC between some brain networks in PSF patients with chronic cerebral infarction may lead to cognitive dysfunction. The decrease of sFNC in RFPN-VN is speculated to be an inhibitory compensatory effect caused by excessive advanced executive network function.

Key words: brain infarction, post-stroke fatigue, functional magnetic resonance imaging, small world property, static functional network connectivity

中图分类号:

R743.33

刘秀颖, 崔凯歌, 刘丽莹, 吴艳凯, 于佳琪, 杨冀萍. 基于静息态功能磁共振成像探讨卒中后疲劳的中枢机制[J]. 临床荟萃, 2024, 39(5): 401-407.

Liu Xiuying, Cui Kaige, Liu Liying, Wu Yankai, Yu Jiaqi, Yang Jiping. Exploration of central mechanisms for post-stroke fatigue based on resting-state functional magnetic resonance imaging[J]. Clinical Focus, 2024, 39(5): 401-407.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.05.003

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I5/401

图/表 7

图1 RSNs示意图

Fig.1 Sketch map of RSNs

表1 脑梗死急性期两组一般资料和NIHSS评分比较

Tab.1 Comparison of general information and NIHSS scores between groups in the acute phase of cerebral infarction

组别	例数	性别[例(%)]		年龄 (岁)	NIHSS评分 (分)
组别	例数	男性	女性	年龄 (岁)	NIHSS评分 (分)
PSF组	40	26(65.0)	14(35.0)	54.27±10.27	3.70±2.30
NPSF组	35	24(68.6)	11(31.4)	54.23±9.66	2.20±1.80
统计值		χ²=0.107		t=0.153	t=3.126
P值		0.809		0.832	0.096

表2 脑梗死急性期两组小世界属性的特征性参数比较

Tab.2 Comparison of characteristic parameters of small-world properties between groups in the acute period of cerebral infarction

组别	例数	AUC
组别	例数	σ	γ	λ	Cp	Lp
PSF组	40	0.58±0.13	0.67±0.14	0.40±0.02	0.20±0.01	0.75±0.07
NPSF组	35	0.62±0.12	0.71±0.13	0.39±0.02	0.20±0.01	0.74±0.08
统计值		t=1.522	t=1.333	t=1.175	t=0.487	t=1.004
P值		0.132	0.187	0.244	0.628	0.319

图2 脑梗死急性期两组功能连接注:不同脑区间的连线表示其功能连接,红色表示增强,蓝色表示减弱

Fig.2 Correlation analysis between groups in the acute period of cerebral infarction Note : The connection between different brain regions indicates functional connection, red indicates enhancement, and blue indicates weakening

表3 脑梗死慢性期两组一般资料比较

Tab.3 Comparison of general information between groups in the chronic phase of cerebral infarction

组别	例数	性别[例(%)]		年龄(岁)
组别	例数	男性	女性	年龄(岁)
PSF组	34	24(70.6)	10(29.4)	56.38±8.77
NPSF组	20	12(60.0)	8(40.0)	52.85±10.21
统计值		χ²=0.635		t=1.345
P值		0.425		0.537

表4 脑梗死慢性期两组小世界属性的特征性参数比较

Tab.4 Comparison of characteristic parameters of small world attributes between groups in chronic phase of cerebral infarction

组别	例数	AUC
组别	例数	σ	γ	λ	Cp	Lp
PSF组	40	0.57±0.09	0.65±0.10	0.39±0.01	0.20±0.01	0.74±0.05
NPSF组	35	0.56±0.13	0.66±0.14	0.40±0.02	0.20±0.01	0.77±0.08
统计值		t=0.197	t=0.198	t=1.890	t=2.029	t=1.335
P值		0.845	0.828	0.036	0.048	1.145

图3 脑梗死慢性期两组功能连接注:不同脑区间的连线表示其功能连接,红色表示增强,蓝色表示减弱

Fig.3 Correlation analysis between PSF group and NPSF group in the chronic phase of cerebral infarction Note : The connection between different brain regions indicates functional connection, red indicates enhancement, and blue indicates weakening

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