摘要
目的探讨实时功能磁共振神经反馈(real-time functional magnetic resonance imaging neurofeedback,rtfMRI-NF)调控杏仁核活动对失眠障碍患者脑功能局部一致性(regional homogeneity,ReHo)及情绪相关神经递质的影响。方法20例失眠障碍患者采用rtfMRI-NF上调杏仁核活动,每周训练1次,连续3周。rtfMRI-NF首次训练前、第3次训练结束后行匹兹堡睡眠质量指数、失眠严重指数量表、汉密尔顿抑郁量表、汉密尔顿焦虑量表评分;检测血清情绪相关神经递质5-羟色胺、谷氨酸、多巴胺、γ-氨基丁酸、去甲肾上腺素水平;行静息态功能磁共振成像检查,计算训练前后各脑区ReHo值,并进行比较。采用Pearson相关法分析失眠障碍患者训练前后右侧脑岛ReHo值变化值与血清5-羟色胺、谷氨酸水平变化值的相关性。结果失眠障碍患者训练后血清5-羟色胺[(0.213±0.110)μmol/L]、谷氨酸[(46.430±19.454)μmol/L]水平均低于训练前[(0.554±0.298)、(70.142±26.333)μmol/L](t=4.795,P<0.001;t=3.312,P=0.002),多巴胺、γ-氨基丁酸、去甲肾上腺素水平与训练前比较差异均无统计学意义(P>0.05)。失眠障碍患者训练后匹兹堡睡眠质量指数评分[(11.350±3.409)分]、失眠严重指数量表评分[(13.550±6.103)分]、汉密尔顿抑郁量表评分[(15.900±7.809)分]均低于训练前[(13.600±3.555)、(16.750±5.594)、(18.700±7.140)分](P<0.05),汉密尔顿焦虑量表评分[(16.100±12.340)分]与训练前[(19.350±10.762)分]比较差异无统计学意义(t=1.719,P=0.101)。失眠障碍患者训练后右侧脑岛(-0.001±0.356)、右侧岛盖部额下回(0.044±0.372)、右侧尾状核(-0.355±0.208)、右侧豆状核(-0.246±0.255)、右侧颞极颞上回(-0.269±0.349)、右侧三角部额下回(-0.079±0.325)、右侧眶部额下回(-0.423±0.247)、右侧中央沟盖(-0.102±0.372)ReHo值均低于训练前(0.265±0.408、0.346±0.371、-0.189±0.267、-0.003±0.360、0.042±0.450、0.109±0.242、-0.259±0.256、0.199±0.413)(P<0.05)。失眠障碍患者训练后右侧脑岛ReHo降低值与血清5-羟色胺、谷氨酸水平降低值均呈正相关(r=0.530,P=0.016;r=0.460,P=0.041)。结论失眠障碍患者经rtfMRI-NF训练后血清5-羟色胺、谷氨酸水平降低,右侧脑岛神经元活动ReHo下降,二者变化程度呈正相关,进而改善抑郁情绪、缓解失眠症状。
Objective To investigate the influence of real-time functional magnetic resonance imaging neurofeedback(rtfMRI-NF)regulating amygdala activity on brain function regional homogeneity(ReHo)and mood related neurotransmitters in patients with insomnia disorder.Methods In 20patients with insomnia disorder,rtfMRI-NF was used to regulate the amygdala activity once a week for 3consecutive weeks.Pittsburgh sleep quality index(PSQI),insomnia severity index scale(ISI),Hamilton depression scale(HAMD)and Hamilton anxiety scale(HAMA)were done before the first rtfMRI-NF training and after three times of training.The levels of 5-hydroxytryptamine,glutamate,dopamine,γ-aminobutyric acid and noradrenaline were detected.Resting-state functional magnetic resonance imaging(rs-fMRI)was performed,and the ReHo values of each brain region were calculated and compared before and after training.Pearson correlation analysis was done to assess the correlations of the changes of ReHo value in Insula_R with the changes of serum serotonin and glutamate levels before and after training.Results The levels of serum 5-hydroxytryptamine and glutamate were lower in patients with insomnia after training[(0.213±0.110),(46.430±19.454)μmol/L]than those before training・'[(0.554±0.298),(70.142±26.333)μmol/L](t=4.795,P<0.001;t=3.312,P=0.002).There were no significant differences in the levels of dopamine,γ-aminobutyric acid and noradrenaline after training(P>0.05).Pittsburgh sleep quality index,insomnia severity index,and Hamilton depression scale were lower after training(11.350±3.409,13.550±6.103,15.900±7.809)than those before training(13.600±3.555,16.750±5.594,18.700±7.140)(P<0.05),and there was no significant difference in Hamilton anxiety scale after training(16.100±12.340)compared with that before training(19.350±10.762)(t=1.719,P=0.101).After training,the ReHo values of Insula_R(-0.001±0.356),Frontal_Inf_Oper_R(0.044±0.372),Caudate_R(-0.355±0.208),Putamen_R(-0.246±0.255),Temporal_Pole_Sup_R(-0.269±0.349),Frontal_Inf_Tri_R(-0.079±0.325),Frontal_Inf_Orb_R(-0.423±0.247),and Rolandic_Oper_R(-0.102±0.372)after training were lower than those before training(0.265±0.408,0.346±0.371,-0.189±0.267,-0.003±0.360,0.042±0.450,0.109±0.242,-0.259±0.256,0.199±0.413)(P<0.05).The decreased value of ReHo in Insula_R after training was positively correlated with the decreased serum 5-hydroxytryptamine(r=0.530,P=0.016)and glutamate(r=0.460,P=0.041)in patients with insomnia disorder.Conclusion rtfMRI-NF training can lower the levels of serum 5-hydroxytryptamine and glutamate and decrease the ReHo value of neuron activity in Insula_R so as to alleviate depression and insomnia symptoms in patients with insomnia disorder,and the changes of serum 5-hydroxytryptamine and glutamate are positively correlated with ReHo value in Insula_R.
作者
祁菲
张欢
李中林
武肖玲
王彩云
邹智
周菁
窦社伟
闫峰山
张淼
和俊雅
戚昕
李永丽
QI Fei;ZHANG Huan;LI Zhong-lin;WU Xiao-ling;WANG Cai-yun;ZOU Zhi;ZHOU Jing;DOU She-wei;YAN Feng-shan;ZHANG Miao;HE Jun-ya;QI Xin;LI Yong-li(Department of Radiology,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China;Zhejiang Lab,Research Center for Human-Machine Augmented Intelligence,Research Institute of Artificial Intelligence,Hangzhou,Zhejiang 311100,China;Department of Nuclear Medicine,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Health Management,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2022年第12期1255-1259,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家自然科学基金面上项目(82071884)
河南省中青年卫生健康科技创新领军人才培养项目(YXKC2020004)
河南省医学科技攻关计划联合共建项目(LHGJ20200060)。
关键词
失眠障碍
实时功能磁共振神经反馈
5-羟色胺
谷氨酸
静息态功能磁共振成像
局部一致性
insomnia disorder
real-time functional magnetic resonance imaging neurofeedback
5-hydroxytryptamine
glutamate
resting-state functional magnetic resonance imaging
regional homogeneity
作者简介
通信作者:李永丽,E-mail:shyliyongli@126.com。
