脑静息态功能磁共振局部一致性分析在老年人脑白质病变相关性跌倒中的初步研究

摘要

目的 采用静息态功能磁共振序列(resting-state functional magnetic resonance imaging,rs-fMRI)探讨伴有跌倒风险的脑白质病变(white matter lesions,WMLs)患者脑局部一致性(regional homogeneity,ReHo)改变.材料与方法 选择60岁以上的WMLs患者,根据Tinetti平衡和步态量表划分为跌倒风险组(Tinetti<25分)及对照组(Tinetti≥25分),计算静息态ReHo值,提取两组患者存在显著差异脑区的ReHo值,并与临床数据做相关分析.结果 跌倒风险组的蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)(t=3.881,P<0.01)及简易智力状态检查量表(mini mental state exam,MMSE)(t=4.041,P<0.01)评分低于对照组.跌倒风险组患者的左额上回、右额中回、右额下回的平均ReHo值减低;右额中回、右额下回的ReHo值与MMSE及MOCA量表呈正相关,左额上回的ReHo值与MMSE量表呈正相关.右侧补充运动区、左侧初级运动皮层、左背侧后扣带皮层、左梭状回、左侧小脑3区、4区、5区、6区、右侧小脑10区的平均ReHo值增加,所有患者这些脑区的平均ReHo值与MMSE、MOCA量表呈负相关.结论 跌倒风险患者存在多个脑区的局部一致性异常,并与认知功能改变存在一定的相关性.%Objective: The application of resting state fMRI (rs-fMRI) was used for exploring the regional homogeneity in the aged who had white matter lesions (WMLs) with fall risks. Materials and Methods: The aged more than 60 years old with WMLs were included in study, according to the Tinetti Balance and gait analysis, all patients were divided into experimental group (Tinetti<25) and contrast group (Tinetti≥25). Regional homogeneity (ReHo) values were calculated respectively and correlation analysis was conducted between ReHo values and mini mental state exam (MMSE) and Montreal cognitive assessment (MoCA) extracted from significantly different brain regions. Results: There was statistic significance in the score of MoCA (t=3.881, P<0.01) and MMSE (t=4.041, P<0.01) between two groups with WMLs. In subjects with risk of falls, the mean ReHo values of left superior frontal gyrus, right middle frontal gyrus, right inferior frontal gyrus decreased, and the mean ReHo values of right middle frontal gyrus, right inferior frontal gyrus were positively correlated with MMSE and MoCA, the mean ReHo values of left superior frontal gyrus was positively correlated with MMSE. The mean ReHo values of right supplementary motor area, left primary motor cortex, left dorsal posterior cingular cortex, left fusiform gyrus, left cerebellum 3, 4, 5, 6 region, right cerebellum 10 region increased, and were negatively correlated with MMSE and MoCA. Conclusions: In subjects with fall risk, the regional homogeneity changed, these differences were correlated with cognitive function.