目的 探讨体素镜像同伦连接(voxel-mirrored homotopic connectivity,VMHC)与局部一致性(regional homogeneity,ReHo)在评价经颅直流电刺激(transcranial direct current stimulation,tDCS)改善脑卒中后认知障碍中的应用价值.材料与方法 前瞻性纳入47名脑卒中后认知障碍(post-stroke cognitive impairment,PSCI)患者,随机分配到tDCS组与假刺激组,其中tDCS组23人,假刺激组24人,应用Mann-Whitney U检验比较两组患者在基线期与15天tDCS或假刺激治疗后认知量表评分变化值的差异,应用配对t检验比较两组患者在基线期与15天tDCS或假刺激治疗后VMHC与ReHo指标的差异,并提取差异脑区的VMHC与ReHo值与治疗前后认知量表评分的变化值进行相关性分析.结果 tDCS组与假刺激组在治疗后的简易智能精神状态量表(Mini-Mental State Examination,MMSE)与蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评分均优于治疗前,但tDCS组具有更好的治疗效果,治疗后相较于治疗前MMSE与MoCA量表评分改善值更大,差异具有统计学意义(P<0.05);VMHC指标结果:tDCS组患者在治疗后,双侧岛叶、楔前叶的VMHC值升高(P<0.05,FDR校正),假刺激组患者在治疗后,在双侧枕上回的VMHC值升高(P<0.05,FDR校正);ReHo指标结果:tDCS组患者在治疗后,前扣带回和顶下缘角回的ReHo值升高(P<0.05,FDR校正),假刺激组患者在治疗后相较于治疗前,未见明显差异脑区;相关性分析:tDCS组患者在治疗后,双侧楔前叶VMHC增加的值与MMSE、MoCA量表评分的变化值呈现正相关,MMSE(r=0.47,P=0.02);MoCA(r=0.43,P= 0.04);其他差异脑区与MMSE与MoCA量表评分变化值无明显相关性.结论 tDCS联合常规康复治疗对PSCI患者的认知康复效果优于仅进行常规康复治疗手段,应用VMHC与ReHo发现tDCS的治疗机制可能与改善默认模式网络(default mode network,DMN)与突显网络(salience network,SN)中部分脑区在双侧大脑半球之间的功能连接与自发活动有关.
Application value of VMHC and ReHo in evaluating tDCS in improving cognitive impairment after stroke
Objective:Exploring the application value of voxel-mirror homotopic connectivity(VMHC)and regional homogeneity(ReHo)in evaluating transcranial direct current stimulation(tDCS)in improving cognitive impairment after stroke.Materials and Methods:A total of 47 patients with post-stroke cognitive impairment(PSCI)were prospectively included and randomly assigned to the tDCS group and sham stimulation group.Among them,23 patients were in the tDCS group and 24 patients were in the sham stimulation group.Use Mann Whitney U-test to compare the differences in cognitive scale scores between two groups of patients at baseline and 15 days after tDCS or sham stimulation treatment.Use paired t-test to compare the differences in VMHC and ReHo result between two groups of patients at baseline and 15 days after tDCS or sham stimulation treatment.Collect and extract VMHC and ReHo values of different brain regions for correlation analysis with changes in scale scores before and after treatment.Results:The Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA)scores of the tDCS group and the sham stimulation group after treatment were better than before treatment,but the tDCS group had better treatment effect.After treatment,the MMSE and MoCA scores improved significantly compared to before treatment,with a statistically significant difference(P<0.05);VMHC results:After treatment,the VMHC values in the bilateral insula and anterior cuneiform lobes of patients in the tDCS group increased(P<0.05,FDR correction),while the VMHC values in the bilateral superior occipital gyrus of patients in the sham stimulation group increased(P<0.05,FDR correction);ReHo results:After treatment,the ReHo values in the anterior cingulate gyrus and inferior parietal angular gyrus of patients in the tDCS group increased(P<0.05,FDR correction),while there was no significant difference in brain regions between the sham stimulation group and before treatment;Correlation analysis:After treatment,the increase in VMHC in the bilateral anterior cuneiform lobes of patients in the tDCS group showed a positive correlation with changes in MMSE and MoCA scales;MMSE(r=0.47,P=0.02);MoCA(r=0.43,P=0.04),while there was no significant correlation between other brain regions and changes in MMSE and MoCA scales.Conclusions:The cognitive rehabilitation effect of tDCS combined with conventional rehabilitation treatment on PSCI patients is better than that of conventional rehabilitation treatment alone.The application of VMHC and ReHo found that the treatment mechanism of tDCS may be related to improving the functional connectivity and spontaneous activity of some brain regions between the bilateral hemispheres in the default mode network(DMN)and salience network(SN).
万方数据
维普
