慢性失眠障碍伴或不伴抑郁患者背外侧前额叶亚区脑功能连接特征的研究
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国家自然科学基金 (82001803,82371479);四川省科技厅项目 (2020YJ0197);成都市科技局项目 (2021-YF05-00247SN)


Characteristics of dorsolateral prefrontal cortex subregion functional connectivity in patients with chronic insomnia disorder with or without depressive disorder
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    摘要:

    目的 研究慢性失眠障碍(CID)伴抑郁患者背外侧前额叶(DLPFC)不同亚区脑网络改变 的特征。方法 选取 2021 年 1 月— 2022 年 6 月成都市第二人民医院门诊及周边社区医院招募的 102 例 CID 患者与 38 名睡眠良好对照者(GSC)为研究对象。所有受试者接受全面的神经心理测试和 MRI 检查。 采用匹兹堡睡眠质量指数(PSQI)、抑郁自评量表(SDS)和焦虑自评量表(SAS)评估参与者睡眠质量、抑郁 及焦虑情况。在数据预处理过程中,排除了 12 例参与者(其中 10 例为 CID 患者,2 名为 GSC)。根据 SDS 评分,将 92 例 CID 患者分为 CID 伴抑郁组(CID-D 组,SDS 评分≥ 53 分,n=36)及 CID 不伴抑郁组(CID-ND 组,SDS 评分< 53 分,n=56)。从 Brainnetome 脑图谱选择 DLPFC 的 14 个亚区(双侧 A9/46d,额下联合皮 层(IFJ),A46,A9/46v,A8vl,A6vl,A10l)进行基于种子点构建 DLPFC 亚区的功能连接网络。采用基于体 素的方差分析,比较三组 DLPFC 各亚区脑网络的差异。采用 Pearson 相关分析 DLPFC 亚区脑网络特征 与抑郁及失眠的相关性。结果 三组性别、年龄、受教育年限方面比较,差异无统计学意义(均P>0.05)。 CID-D 组、CID-ND 组 PSQI、SAS 和 SDS 评分均高于 GSC 组,差异均有统计学意义(均P< 0.05);CID-D 组 与 CID-ND 组在 PSQI 评分、病程方面比较,差异无统计学意义(均P> 0.05)。单因素方差分析结果显 示,DLPFC 不同亚区 FC 改变在三组之间差异有统计学意义(P< 0.05)。在 14 个 DLPFC 亚区中,有 10 个 DLPFC 亚区(双侧 A9/46d,双侧 IFJ,R.A46,双侧 A9/46v,L.A8vl,双侧 A6vl)脑网络存在差异,其中,与 GSC 组相比,CID-D 组、CID-ND 组患者均升高的 DLPFC 亚区网络包括:R.A9/46d 与右颞中回;R.A46 与 左颞中回;L.A9/46v 与左额下回、左额中回;R.A9/46v 与双侧颞中回、双侧颞上回。CID-D 组、CID-ND 组 患者均降低的 DLPFC 亚区网络包括:L.A9/46d 与双侧距状皮层;R.A46 与左额下回、左额中回。进一步 分析显示,与 CID-ND 组相比,CID-D 组升高的 DLPFC 亚区网络包括:L.IFJ 与右颞中回、右颞上回;R.IFJ 与左中央后回;L.A6vl 与右颞上回、右颞中回;降低的 DLFPC 亚区网络包括:R.A9/46d 与左壳核、左尾状 核、左丘脑;L.A9/46v 与左额下回、左额中回;L.A8vl 与左尾状核、左壳核;R.A6vl 与双侧尾状核。CID 组 患者改变的 DLPFC 亚区 FC 与抑郁症状的相关性分析显示,R.A9/46d(r=-0.30,P=0.003)与左壳核、左尾 状核、左丘脑,L.A8vl(r=-0.35,P< 0.001)与左尾状核、左壳核,R.A6vl(r=-0.28,P=0.008)与双侧尾状核 的 FC 值与 SDS 评分呈负相关;L.IFJ(r=0.33,P=0.001)与右颞中回、右颞上回,R.IFJ(r=0.33,P=0.001)与 左中央后回,L.A6vl(r=0.39,P< 0.001)与右颞上回、右颞中回的 FC 值与 SDS 评分呈正相关。结论 CID 患者 DLPFC 亚区 FC 变化,提示失眠涉及注意力、情绪调节和记忆处理等区域内的连接异常。

    Abstract:

    Objective To explore the characteristics of brain network changes in different subregions of the dorsolateral prefrontal cortex (DLPFC) in patients with chronic insomnia disorder (CID) accompanied by depressive disorder. Methods A total of 102 CID patients recruited from outpatient clinics of the Chengdu Second People's Hospital and neighboring community hospitals from January 2021 to June 2022 with 38 good sleep controls (GSC) were selected for the study. All subjects underwent comprehensive neuropsychological testing and MRI. Pittsburgh Sleep Quality Index (PSQI), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS) were used to assess participants' sleep quality, depression, and anxiety. During data preprocessing, 12 participants were excluded (10 of them were CID patients and 2 were GSC). Based on SDS scores, 92 patients with CID were categorized into CID with depressive disorder group (CID-D group, SDS scores ≥ 53, n=36) and CID with non-depressive disorder group (CID-ND group, SDS scores < 53,n=56). Fourteen subregions of the DLPFC [bilateral A9/46d, inferior frontal joint cortex (IFJ), A46, A9/46v, A8vl, A6vl, A10l] were selected from the Brainnetome brain atlas for the construction of a functional connectivity network of the DLPFC subregions based on seed points. A voxel-based analysis of variance (ANOVA) was used to compare the differences in the brain networks of the subregions of the DLPFC among the three groups. Pearson correlation was used to analyze the correlation between brain network characteristics of DLPFC subregions and depressive disorder and insomnia. Results There were no statistically significant differences between the three groups in terms of gender, age, and years of education (all P> 0.05). PSQI, SAS and SDS scores were higher in CID-D and CID-ND groups than in GSC group, and the differences were statistically significant (all P < 0.05). There was no statistically significant difference between CID-D and CID-ND groups in terms of PSQI scores and duration of disease (all P > 0.05). One-way ANOVA showed that the differences in FC changes in different subregions of DLPFC were statistically significant among the three groups (P < 0.05). Among the 14 DLPFC subregions, there were differences in brain networks in 10 DLPFC subregions (bilateral A9/46d, bilateral IFJ, R.A46, bilateral A9/46v, L.A8vl, and bilateral A6vl), of which, the DLPFC subregion networks that were elevated in patients in both CID-D group and CID-ND group, compared with those in GSC group, included R.A9/46d with right temporal middle gyrus, R.A46 with left middle temporal gyrus, L.A9/46v with left inferior frontal gyrus and left middle frontal gyrus, and R.A9/46v with bilateral middle temporal gyrus and bilateral superior temporal gyrus. The network of DLPFC subregions that were reduced in both CID-D and CID-ND group patients included L.A9/46d with bilateral talar cortex, R.A46 with left inferior frontal gyrus and left middle frontal gyrus. Further analysis showed that compared with CID-ND group, the network of elevated DLPFC subregions in CID-D group included L.IFJ with the right middle temporal gyrus and right superior temporal gyrus, R.IFJ with the left postcentral gyrus, L.A6vl with the right superior temporal gyrus and the right middle temporal gyrus, and the network of reduced DLFPC subregions included R.A9/46d with the left crustal nucleus, left caudate nucleus, and left thalamus, and L.A9/46v with left inferior frontal gyrus, left middle frontal gyrus, and L.A8vl with left caudate nucleus, left shell nucleus and R.A6vl with bilateral caudate nuclei. Correlation analysis between FC of altered DLPFC subregions and depressive symptoms in patients in CID group showed that R.A9/46d (r=-0.30,P=0.003) was negatively associated with left chiasmatic nucleus, left caudate nucleus, and left thalamus, L.A8vl (r=-0.35,P < 0.001) was negatively associated with left caudate nucleus and left chiasmatic nucleus, and R.A6vl (r=-0.28, P=0.008) was negatively associated with FC values in the bilateral caudate nucleus and SDS scores. L.IFJ (r=0.33, P=0.001) was positively correlated with right middle temporal gyrus and right superior temporal gyrus, and R.IFJ (r=0.33, P=0.001) was positively correlated with left postcentral gyrus, and L.A6vl (r=0.39, P< 0.001) was positively correlated with FC value of right superior temporal gyrus and right middle temporal gyrus, as well as SDS scores. Conclusions FC changes in the DLPFC subregion in patients with CID suggest that insomnia involves abnormal connectivity within regions of attention, emotion regulation, and memory processing

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张上,张宏玉,罗伟诚,何媛,龚亮.慢性失眠障碍伴或不伴抑郁患者背外侧前额叶亚区脑功能连接特征的研究[J].神经疾病与精神卫生,2025,25(3):192-201
DOI :10.3969/j. issn.1009-6574.2025.03.007.

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  • 在线发布日期: 2025-03-28