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目的确定多发性硬化不同亚型中小脑与前额区之间的功能连接是否发生改变及其与认知障碍的相关性。材料与方法研究经单位伦理委员会批准,每位被试者签署知情同意书。对17例复发缓解型病例、17例良性、23例继发进展型多发性硬化病人和18例健康对照者进行心理生理互动分析,采用Stroop功能MRI评价右侧小脑半球与其他脑区之间的激活与有效连接(P<0.05,激活阈值)。当存在不一致时,评价疾病病程、T2病变体积、脑容量和反应时间之间的相关性(P<0.001,未校正)。结果激活图和心理生理互动分析显示,复发缓解型病例较与其他组存在左侧额顶叶异常激活区,而继发进展型较复发缓解型存在扣带回和楔前叶的激活异常。良性多发性硬化组右侧前额叶皮质激活增加,并且这些区域与右侧小脑半球联系增强。在健康受试者,反应时间与右侧小脑半球和数个额顶部脑区激活呈负相关。在多发性硬化病人中,反应时间与双侧小脑半球的活动呈负相关,而与右侧楔前叶活动直接相关。在多发性硬化病人,疾病的病程与右侧小脑半球活动呈负相关,与左侧额下回和楔前叶活动直接相关。T2高信号病变体积和较小的脑容量与以上这些脑区活动存在相关性。结论不同临床亚型的多发性硬化病人存在右侧小脑半球和额顶叶脑区的异常激活和有效功能连接异常,从而导致无效的皮质重组,加重认知负荷形成认知障碍。
Objective To determine whether there is a change in functional connectivity between the cerebellar and prefrontal areas in different subtypes of multiple sclerosis and its association with cognitive impairment. Materials and Methods Approved by the Ethics Committee, each subject signed an informed consent form. 17 cases of relapsing-remitting type, 17 cases of benign, 23 cases of patients with secondary progressive multiple sclerosis and 18 healthy controls were analyzed by psychophysiological interaction, using Stroop functional MRI to evaluate the relationship between the right cerebellar hemisphere and other brain regions Activation and efficient ligation (P <0.05, activation threshold). When there was an inconsistency, the correlation between disease course, T2 lesion volume, brain volume, and reaction time was evaluated (P <0.001, uncorrected). Results The interaction between activation diagram and psychophysiological analysis showed that the patients with recurrent remission had abnormal frontal parietal lobe activation compared with other groups. However, there was abnormal activation of cingulate gyrus and anterior wedge leaf in the secondary progressive recurrent remission. Right benign prefrontal cortex activation is increased in benign multiple sclerosis, and these areas are associated with increased right cerebellar hemispheres. In healthy subjects, reaction time was negatively correlated with activation of the right cerebellar hemisphere and several frontal brain regions. In patients with multiple sclerosis, reaction time was negatively correlated with bilateral cerebellar hemispheres and directly with right wedge anterior leaflet activity. In patients with multiple sclerosis, the course of the disease is inversely related to the activity of the right cerebellar hemisphere and directly to the left inferior frontal gyrus and the wedge anterior leaflet activity. T2 hyperintense lesion volume and smaller brain volume correlate with these brain regions. Conclusion In patients with multiple sclerosis of different clinical subtypes, abnormal activation and abnormal functional connectivity in the right cerebellar hemispheres and frontal parietal lobes exist, leading to ineffective cortical reorganization and aggravating the cognitive load to form cognitive disorders.