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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (6): 1158-1162. doi: 10.19723/j.issn.1671-167X.2022.06.016

• 论著 • 上一篇    下一篇

肌萎缩侧索硬化患者认知功能改变与脑皮层厚度分析

叶珊1,2,金萍萍1,2,张楠1,2,邬海博3,石林4,5,赵强3,杨坤3,袁慧书3,樊东升1,2,*()   

  1. 1. 北京大学第三医院神经内科，北京 100191
    2. 神经退行性疾病生物标志物研究及转化北京市重点实验室，北京 100191
    3. 北京大学第三医院放射科，北京 100191
    4. 香港中文大学威尔斯亲王医院影像及介入放射学系，中国香港特别行政区 000852
    5. 深圳博脑研究院，广东深圳 518000
  • 收稿日期:2020-03-21 出版日期:2022-12-18 发布日期:2022-12-19
  • 通讯作者: 樊东升 E-mail:dsfan2010@aliyun.com
  • 基金资助:
    国家自然科学基金(82001350);北京大学第三医院临床重点项目(BYSY2018048);北京大学第三医院院队列建设项目(BYSYDL2019002)

Cortical thickness and cognitive impairment in patients with amyotrophic lateral sclerosis

Shan YE1,2,Ping-ping JIN1,2,Nan ZHANG1,2,Hai-bo WU3,Lin SHI4,5,Qiang ZHAO3,Kun YANG3,Hui-shu YUAN3,Dong-sheng FAN1,2,*()   

  1. 1. Department of Neurology, Peking University Third Hospital, Beijing 100191, China
    2. Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing 100191, China
    3. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
    4. Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region 000852, China
    5. BrainNow Research Institute, Shenzhen 518000, Guangdong, China
  • Received:2020-03-21 Online:2022-12-18 Published:2022-12-19
  • Contact: Dong-sheng FAN E-mail:dsfan2010@aliyun.com
  • Supported by:
    the National Natural Science Foundation of China(82001350);the Peking University Third Hospital Key Clinical Projects(BYSY2018048);the Peking University Third Hospital Cohort Construction Project(BYSYDL2019002)

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摘要：

目的: 通过MRI皮层厚度分析法，探讨肌萎缩侧索硬化(amyotrophic lateral sclerosis, ALS)患者脑结构变化，并分析其与认知功能改变的相关性。方法: 纳入ALS患者18例，以及性别、年龄、教育程度匹配的正常对照者18例，对所有研究对象进行3D磁化准备快速递度回波(magnetization prepared rapid gradient echo imaging, MPRAGE)序列MRI扫描，进行皮层厚度分析，同时对所有ALS患者进行神经心理学测评，包括简易精神状态检查(mini-mental state examination，MMSE)、言语流畅性试验、Stroop色词试验、前瞻性记忆、情绪图片感知及再认、失言识别测验。结果: 经过认知评估，2例ALS患者存在认知功能障碍。比较18例ALS患者和18例正常对照的顶点水平全脑皮层厚度，ALS组左侧大脑半球内侧眶额叶后部、颞叶内侧皮层厚度明显减低(P < 0.05)；区域水平比较，ALS组左内嗅区、左颞下回、左内侧眶额叶、左岛叶皮层厚度明显减低(P < 0.05)。认知功能正常的16例ALS患者与正常对照相比较，两组间顶点水平和区域水平的皮层厚度差异均无统计学意义(P>0.05)。前瞻性记忆、情绪图片感知及再认、失言识别测验评分与对应脑区皮层厚度值存在相关性(P < 0.05)。结论: ALS患者皮层厚度与神经心理学检查具有相关性，可能反映认知测评所对应的脑区皮层结构改变，可能为ALS患者认知改变的早期诊断提供帮助。

关键词: 肌萎缩侧索硬化, 磁共振成像, 大脑皮质, 认知

Abstract:

Objective: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with high morbidity and mortality. There are about 5%-15% of ALS patients combining with frontotemporal lobe degeneration (FTLD) at the same time and 50% of patients combing with cognitive function changes. The analysis of cortical thickness based on MRI is an important imaging method to evaluate brain structure. The aim of the study was to explore the changes of brain structure in ALS patients by cortical thickness analysis, and to explore the correlation between the brain structure and cognitive function. Methods: In the study, 18 ALS patients treated in Department of Neurology, Peking University Third Hospital and 18 normal controls (age, gender and education level matched) were included. 3D magnetization prepared rapid gradient echo imaging (MPRAGE) sequence MRI was performed and the cortical thickness was analyzed. At the same time, all the ALS patients took neuropsychology assessments, including: mini-mental state examination (MMSE), verbal fluency test (VFT), Stroop color word test (SCWT), prospective memory (PM), emotional picture perception and recognition, and faux pas story test. Results: After cognitive assessment, two ALS patients had cognitive impairment. One was in accordance with ALS-frontotemporal dementia (FTD) diagnosis and the other one was in accordance with ALS cognitive impairment (ALSci) diagnosis. In all the 18 ALS patients and 18 normal controls, the cortical thickness of the left medial orbitofrontal lobe and the medial temporal lobe were significantly reduced (P < 0.05) in ALS group by the vertex-wise comparison. Cortical thickness of the left entorhinal cortex, the left inferior temporal gyrus, the left medial orbitofrontal lobe and the left insular lobe was significantly reduced (P < 0.05) by the region-wise comparison. However, when only concluded the 16 ALS non-cognitive impairment patients, there was no significant difference between the two groups (P>0.05). There were correlations between the scores of prospective memory, emotional picture perception and recognition, faux pas story test and the cortical thickness of their corresponding regions (P < 0.05). Conclusion: The cortical thickness of ALS patients are correlated with neuropsychological scores which may reflect the changes of cortical structure corresponding to the cognitive assessment, and may provide help for the early diagnosis of cognitive changes in ALS patients.

Key words: Amyotrophic lateral sclerosis, Magnetic resonance imaging, Cerebral cortex, Cognition

中图分类号: 

  • R744.8

表1

ALS组和正常对照组的基本人口学和临床信息"

Items Normal control group ALS group
Male, n (%) 7/18 (38.9) 7/18 (38.9)
Age/years, ${\bar x}$±s 53.7±12.1 52.9±11.8
Education/years, ${\bar x}$±s 11.8±4.8 11.4±4.7
Duration/months, ${\bar x}$±s 13.5±9.3
Region of onset, n (%)
   Bulbar 3/18 (16.7)
   Extremities 15/18 (83.3)
Upper motor neuron, n (%)
   One 0
   Two 3/18 (12.5)
   Three 15/18 (87.5)
Diagnostic level, n (%)
   Definite 3/18 (16.7)
   Probable 8/18 (44.4)
   Lab-supported probable 6/18 (33.3)
   Possible 1/18 (5.5)
ALS-FRS score, ${\bar x}$±s 35.8±7.5
Progression rate, ${\bar x}$±s 1.11±0.83

图1

18例ALS患者与18例正常对照顶点水平皮层厚度的比较"

表2

18例ALS患者与18例正常对照区域水平皮层厚度的比较"

Region ALS patients/mm Normal control/mm P value
Left entorhinal cortex 2.91±0.41 3.14±0.18 0.044
Left inferior temporal gyrus 2.66±0.18 2.77±0.11 0.046
Left medial orbitofrontal lobe 2.08±0.12 2.18±0.12 0.015
Left insula lobe 2.68±0.17 2.78±0.09 0.042

表3

各脑区皮层厚度与EBPM的相关性"

Region Related coefficient P value
Left lateral orbitofrontal lobe 0.523 0.038
Left media orbitofrontal lobe 0.600 0.014
Left pars orbitalis 0.644 0.007
Left pars triangularis 0.526 0.036
Left superior frontal gyrus 0.523 0.034
Right lateral orbitofrontal lobe 0.667 0.005
Right pars orbitalis 0.702 0.002
Right tegmental part of inferior frontal gyrus 0.631 0.009
Right pars triangularis 0.697 0.003
Right middle frontal gyrus 0.669 0.005
Right superior temporal gyrus 0.635 0.008

表4

各脑区皮层厚度与失言相关问题得分的相关性"

Region Related coefficient P value
Left media orbitofrontal lobe 0.614 0.015
Right hippocampal gyrus 0.533 0.041
Right entorhinal cortex 0.599 0.018

表5

各脑区皮层厚度与情绪图片感知和再认"

Neuropsychologic test Related coefficient P value
Negative picture arousal
   Left lateral orbitofrontal lobe 0.627 0.007
   Left inferior temporal gyrus 0.510 0.036
Positive picture recognition rate
   Left entorhinal cortex 0.639 0.006
   Left fusiform gyrus 0.576 0.015
   Left hippocampal gyrus 0.703 0.002
Negative picture recognition rate
   Left fusiform gyrus 0.507 0.038
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ISSN 1671-167X
CN 11-4691/R
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