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原发性夜间遗尿症儿童工作记忆缺陷的功能MRI研究

An event-related functional MRI study on working memory impairment in children with primary nocturnal enuresis

摘要:

目的 评价原发性夜间遗尿症(PNE)患儿的工作记忆水平,探索单纯PNE患儿脑区激活状况.方法 选取23例右利手PNE患儿(试验组)以及20名正常对照组儿童(对照组),首先采用中国韦氏儿童智力量表(C-WISC)进行智力测试,然后进一步计算言语智商(VIQ)、操作智商(PIQ)、总智商(FIQ)、记忆/不分心(M/C)因子等指标,其后进行采用分类N-back范式进行事件相关fMRI扫描,记录反应正确率(PCR)以及平均反应时间(mRT),2组间指标的比较采用t检验.fMRI图像数据采用统计参数图2(SPM2)软件进行后处理,采用组分析的方法寻找单纯PNE患儿脑区激活状况与正常对照组儿童的差异.结果 15例PNE患儿和15名正常对照组儿童的资料可用于评价.试验组患儿FIQ、VIQ和PIQ都在正常水平,与对照组差异无统计学意义(P>0.05).PNE患儿M/C因子(90.4±10.2)低于对照组(99.6±11.9),差异具有统计学意义(t=2.260,P<0.05).在N-Back范式测试中,PNE患儿PCR[(72.7±6.3)%]低于对照组[(86.3±6.7)%](t=5.727,P<0.01),而mRT[(625.8±72.5)ms]长于对照组[(534.8±63.3)ms](t=3.684,P<0.01),差异均有统计学意义.fMRI试验组及对照组的激活区均主要位于右侧额叶背侧、右侧顶叶、左侧颞叶梭状回以及双侧小脑半球后叶,组间分析显示PNE患儿小脑左后部激活程度明显低于对照组(P<0.01).结论 PNE儿童存在工作记忆缺陷,小脑的功能障碍可能与这种功能缺陷有关.

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abstracts:

Objective To assess the working memory and explore the activation of brain areas for children with primary nocturnal enuresis (PNE) with fMRI scan. Methods Twenty three right-handed children with PNE and 20 age-matched right-handed healthy children as the controls were recruited.Intelligence tests were performed by means of Wechsler Young Children Scales of Intelligence (C-WISC) in children with PNE and normal controls. The full intelligence quotient (FIQ), verbal IQ (VIQ),performances IQ (PIQ) and the memory/caution (M/C) factor of PNE children and the controls were measured. After Intelligence tests, an enent-related fMRI scan was performed using the categorial N-Back working memory task. Percent of correct responses (PCR) and mean reaction time to correct response (mRT) were recorded and analyzed by the student t test. The fMRI data were analyzed using Statistical Parametric Mapping 2 (SPM2), the differences in activation were compared between two groups. Results The data of 15 PNE children and 15 healthy children were evaluated. The FIQ, VIQ and PIQ in PNE group were in a normal range and no statistical significance with the control group ( P > 0. 05). M/C factor in the PNE group(90.4 ±10.2)was significantly lower than that in the control group (99. 6 ± 11.9) (t =2. 260,P < 0. 05). In the N-Back test, PNE children had significantly less PCR [(72.7±6.3 ) % vs. ( 86. 3 ±6. 7) %, t = 5. 727,P < 0. 01] and longer mRT [ (625. 8 ± 72.5) ms vs. (534. 8 ± 63. 3 ) ms, t = 3. 684,P < 0.01] than the healthy controls. The activation regions of PNE patients and healthy children were mainly in the dorsal right frontal lobe, right parietal lobe, left temporal lobe gyrus fusiformis and bilateral cerebellum posterior lobe. The activation level in left posterior cerebellar lobe in PNE children was significant lower than that in healthy controls (P<0.01). Conclusion The children with PNE have deficits in working memory which might be associated with the dysfunction of the left cerebellum.

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