孫 偉

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專家論壇

孫 偉

青少年肌陣攣性癲；腦結(jié)構(gòu)網(wǎng)絡(luò)；功能網(wǎng)絡(luò)

大腦是生物體內(nèi)結(jié)構(gòu)和功能最復(fù)雜的器官，同時(shí)它也是極為精巧和完善的信息處理系統(tǒng)。10年前，學(xué)者們提出了“腦網(wǎng)絡(luò)”的概念?！澳X網(wǎng)絡(luò)”主要基于實(shí)驗(yàn)測(cè)量的反映大腦結(jié)構(gòu)性連接的數(shù)據(jù)，或大腦功能性連接的數(shù)據(jù)，計(jì)算預(yù)先定義的腦區(qū)或節(jié)點(diǎn)的連接關(guān)系，然后構(gòu)建網(wǎng)絡(luò)進(jìn)行分析，這是目前應(yīng)用最多的一類“腦網(wǎng)絡(luò)”研究方法。

近年來(lái)，越來(lái)越多的研究證實(shí)，JME患者的腦結(jié)構(gòu)網(wǎng)絡(luò)和功能網(wǎng)絡(luò)(包括靜息態(tài)網(wǎng)絡(luò)和認(rèn)知網(wǎng)絡(luò)等)連接均受到了影響。下面筆者通過(guò)對(duì)JME相關(guān)網(wǎng)絡(luò)的結(jié)構(gòu)連接及功能連接方面的研究做進(jìn)一步的綜述，以期對(duì)近年來(lái)JME網(wǎng)絡(luò)連接進(jìn)展有更深入的了解。

1 JME患者腦結(jié)構(gòu)及結(jié)構(gòu)網(wǎng)絡(luò)連接改變

常規(guī)磁共振成像(magnetic resonance imaging,MRI)和CT(computered tomography,CT)檢查通常不能發(fā)現(xiàn)JME患者大腦結(jié)構(gòu)上微小的變化。近年來(lái)，隨著影像學(xué)技術(shù)的發(fā)展，許多學(xué)者通過(guò)基于體素形態(tài)學(xué)分析(voxel-based morphometry,VBM)和彌散張量成像(diffusion tensor imaging,DTI)等技術(shù)發(fā)現(xiàn)了JME患者大腦的局部結(jié)構(gòu)異常,且異常部位主要集中在額葉結(jié)構(gòu)。VBM是一種基于體素的針對(duì)腦組織結(jié)構(gòu)的形態(tài)學(xué)測(cè)量方法，它通過(guò)計(jì)算磁共振成像(主要是高分辨率的結(jié)構(gòu)掃描圖像)中腦的灰質(zhì)/白質(zhì)的變化，以定量分析不同群體腦結(jié)構(gòu)的特征和腦組織成分的差異，從而替代了傳統(tǒng)上人工勾畫感興趣區(qū)域的方法，提高了測(cè)量的準(zhǔn)確性和可重復(fù)性，能夠準(zhǔn)確、全面評(píng)價(jià)不同群體腦的神經(jīng)解剖變化。1999年, Woermann等[12]應(yīng)用VBM方法首先發(fā)現(xiàn)額中回灰質(zhì)密度發(fā)生變化，為JME患者腦局部結(jié)構(gòu)變化提供了依據(jù)。Pulsipher等[13]發(fā)現(xiàn)，JME患者的丘腦和額葉體積變小。Tae和Betting等[14,15]應(yīng)用VBM證實(shí)了JME患者額葉灰質(zhì)密度的減少。Kim等[16]發(fā)現(xiàn)，JME患者丘腦灰質(zhì)密度與病程呈負(fù)相關(guān)關(guān)系，并提出JME患者可能有丘腦進(jìn)行性神經(jīng)元缺失。

2 JME患者腦功能及功能網(wǎng)絡(luò)連接改變

除了上述提到的應(yīng)用較多的VBM、DTI及fMRI手段外，學(xué)者們還通過(guò)磁共振波譜成像(magnetic resonance spectroscopy, MRS)，正電子發(fā)射斷層顯像(positron emission tomography, PET)及經(jīng)顱磁刺激(transcranial magnetic stimulation，TMS)等技術(shù)研究JME患者的腦網(wǎng)絡(luò)連接變化。Lin等[30]通過(guò)MRS發(fā)現(xiàn)額中前皮質(zhì)、初級(jí)運(yùn)動(dòng)區(qū)以及丘腦N-乙酰天門冬氨酸與肌酐的比值(神經(jīng)元受損的標(biāo)志)下降；額中前皮層、初級(jí)運(yùn)動(dòng)區(qū)及后扣帶回皮質(zhì)谷氨酸/谷氨酰胺與肌酐的比值減低，說(shuō)明了廣泛的大腦皮質(zhì)興奮性降低。Swartz等[31]通過(guò)PET發(fā)現(xiàn)背外側(cè)前額皮質(zhì)、運(yùn)動(dòng)前區(qū)的氟代脫氧葡萄糖減少。同樣，利用PET技術(shù)，Meschaks等[32]發(fā)現(xiàn)JME患者中縫核、海馬、背外側(cè)前額皮質(zhì)的5-羥色胺受體減少。Akgun等[33]通過(guò)TMS證實(shí)JME患者的運(yùn)動(dòng)區(qū)皮質(zhì)興奮性增加。國(guó)內(nèi)侯文生等[34]也運(yùn)用同樣的方法證實(shí)了該結(jié)論。

3 小結(jié)與展望

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(2017-04-10收稿 2017-05-05修回)

(責(zé)任編輯 梁秋野)

國(guó)家自然科學(xué)基金(81571267)

孫 偉，博士，主任醫(yī)師，教授，博士生導(dǎo)師。

100053 北京，首都醫(yī)科大學(xué)宣武醫(yī)院神經(jīng)內(nèi)科

R742.1