| 袁泽琪,张正楠,王惠晓,杨海庆,冯平勇,周立霞,杨冀萍,高铎.失眠障碍神经影像学特征及重复经颅磁刺激治疗效果[J].中国医学影像技术,2025,41(1):40~44 |
| 失眠障碍神经影像学特征及重复经颅磁刺激治疗效果 |
| Neuroimaging features of insomnia disorder and therapeutic effect of repeated transcranial magnetic stimulation |
| 投稿时间：2024-06-26 修订日期：2024-09-18 |
| DOI：10.13929/j.issn.1003-3289.2025.01.009 |
| 中文关键词: 睡眠障碍,昼夜节律性 磁共振成像 低频振幅 局部一致性 功能连接 经颅磁刺激 前瞻性研究 |
| 英文关键词:sleep disorders, circadian rhythm magnetic resonance imaging amplitude of low-frequency fluctuations regional homogeneity functional connectivity transcranial magnetic stimulation prospective studies |
| 基金项目:河北省卫生健康委员会河北医学适用技术跟踪项目计划(GZ20250024)。 |
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| 中文摘要: |
| 目的 基于静息态功能MRI(rs-fMRI)观察失眠障碍(ID)患者脑功能改变,以及重复经颅磁刺激(rTMS)治疗效果。方法 前瞻性纳入37例ID患者(ID组)及20名健康受试者(对照组),比较组间及ID组内rTMS治疗前后睡眠状况及心理状态量表评分;基于颅脑rs-fMRI观察组间低频振幅(ALFF)、局部一致性(ReHo)存在差异脑区,并对其与预设脑区进行体素水平静息态功能连接(FC)分析。结果 治疗前ID组匹兹堡睡眠质量指数(PSQI)、失眠严重程度指数(ISI)、爱普沃斯嗜睡量表(ESS)评分、贝克忧郁量表(BDI)评分及贝克焦虑量表(BAI)评分均高于对照组(P均＜0.05);ID组右侧正中扣带回和扣带旁回(Cingulum_Mid_R)ALFF值及ReHo均低于对照组(FWE校正P均＜0.05),Cingulum_Mid_R与左侧前扣带回和扣带旁回(Cingulum_Ant_L)、左侧海马(Hippocampus_L)与右侧额中回(Frontal_Mid_R)间FC降低(FWE校正P均＜0.05)。rTMS治疗后ID患者PSQI、ISI及ESS评分均较治疗前减低(P均＜0.05),但上述神经影像学指标均无显著改变(FWE校正P均＞0.05)。结论 ID导致Cingulum_Mid_R ALFF值和ReHo同步减低,额叶-扣带回、额叶和边缘系统之间FC减弱。rTMS可改善ID患者睡眠及精神状态,但其对神经影像学的影响尚需进一步观察。 |
| 英文摘要: |
| Objective To observe brain function changes in insomnia disorder (ID) patients and therapeutic effect of repeated transcranial magnetic stimulation (rTMS) based on resting-state functional MRI (rs-fMRI). Methods Totally 37 patients with ID (ID group) and 20 healthy subjects (control group) were prospectively enrolled. The scores of sleep condition and psychological state scales were compared between groups, also within ID group before and after rTMS treatment. Brain regions with amplitude of low frequency fluctuations (ALFF) and regional homogeneity (ReHo) being significantly different between groups were evaluated based on brain rs-fMRI, and voxel-based resting-state functional connectivity (FC) analysis was performed in the above regions and the predefined regions of interest. Results Before treatment, Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), Epworth sleepiness score (ESS), Beck depression inventory (BDI) score and Beck anxiety inventory (BAI) score in ID group were all higher than those in control group (all P＜0.05). ALFF values and ReHo of the right median cingulate and paracingulate gyrus (Cingulum_Mid_R) were lower in ID group than those in control group (all FWE corrected P＜0.05). FC between Cingulum_Mid_R and the left anterior cingulate gyrus and cingulate gyrus (Cingulum_Ant_L) decreased, so did that between the left hippocampus (Hippocampus_L) and the right frontal gyrus (Frontal_Mid_R) ( all FWE corrected P＜0.05). After rTMS, PSQI, ISI and ESS scores of ID patients decreased compared to those before treatment (all P＜0.05), but no significant change of the above neuroimaging indicators was detected (all FWE corrected P＞0.05). Conclusion ID caused synchronous decrease of Cingulum_Mid_R ALFF value and ReHo, as well as weakened FC between frontal cingulate gyrus and frontal with lobe limbic system. rTMS could improve sleep and mental state of ID patients, but its impact on neuroimaging needed further investigation. |
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