摘要目的:探究未服药原发性失眠(PI)患者的动态脑血氧代谢特性，并分析特定脑区的血氧代谢水平与失眠症状的关联。方法:2024年7月至2025年2月纳入31例未服药PI患者和36例健康对照，采用匹兹堡睡眠质量指数量表(PSQI)评估患者的失眠症状。使用功能近红外光谱系统采集被试180 s静息态的背外侧前额叶区(DLPFC)、内侧前额叶、颞叶(TL)、顶叶(PL)和枕叶的脑血氧浓度数据。使用滑动时间窗和K-means聚类算法将被试180 s静息态的脑血氧浓度数据聚类为K个时间类别，采用SPSS 26.0软件对K个时间类别下的脑血氧数据进行 t检验、Wilcoxon秩和检验、 χ2检验、Pearson/Spearman相关分析和多元线性回归分析。 结果:通过聚类发现静息态脑血氧浓度数据呈现4种特征性时间类别(K＝4)。未服药PI患者双侧TL的血氧浓度值在第2个时间类别均高于健康对照[左侧TL(18.19±6.18)mmol/dL，(16.82±4.47)mmol/dL；右侧TL(18.20±8.97)mmol/dL，(16.17±5.64)mmol/dL]、在第3个类别均低于健康对照[左侧TL(16.54± 5.09)mmol/dL，(17.98±5.34)mmol/dL；右侧TL(15.82±7.29)mmol/dL，(17.84±5.94)mmol/dL]，同时右侧PL的血氧浓度值在第2个时间类别低于健康对照[(16.16±6.56)mmol/dL，(17.60±5.84)mmol/dL]，均差异有统计学意义(均 P<0.05)。未服药PI患者第1个时间类别的右侧DLPFC血氧浓度值( β＝0.44， t＝2.52， P＝0.018)，第2个时间类别的左侧DLPFC( β＝－0.47， t＝－2.82， P＝0.009)和右侧PL( β＝－0.46， t＝－2.78， P＝0.010)的血氧浓度值为PSQI评分的影响因素。 结论:未服药PI患者双侧TL和右侧PL的血氧代谢呈现阶段性异常的特点，这可能与失眠导致的大脑内源性节律失常有关。失眠症状与双侧DLPFC和右侧TL的血氧浓度变化存在显著关联。

abstractsObjective:To investigate the dynamic cerebral oxygen metabolism characteristics in drug-naive patients with primary insomnia (PI), and analyze the association between the cerebral oxygen metabolism and insomnia symptoms.Methods:A total of 31 drug-naive patients with PI and 36 healthy controls were recruited from July 2024 to February 2025. Insomnia symptoms were assessed by the Pittsburgh sleep quality index (PSQI). Functional near infrared spectroscopy (fNIRS) technique was employed to collect 180 s resting-state oxygenated hemoglobin concentration changes from dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex, temporal lobe (TL), parietal lobe (PL) and occipital lobe. Sliding time window analysis and K-means clustering algorithm were applied to cluster the oxygenation data into K temporal categories. Statistical analysis, including t-test, Wilcoxon rank-sum test, chi-square test, Pearson/Spearman correlation analysis, and multiple linear regression were performed using SPSS 26.0 software. Results:Clustering analysis revealed 4 characteristic temporal categories (K=4) during the 180 s resting-state. Compared to healthy controls, drug-naive PI patients exhibited higher oxygenation levels in bilateral TLs during the second temporal category(left TL(18.19±6.18)mmol/dL, (16.82±4.47)mmol/dL; right TL(18.20±8.97)mmol/dL, (16.17±5.64)mmol/dL), but lower levels during the third temporal category(left TL(16.54± 5.09)mmol/dL, (17.98±5.34)mmol/dL; right TL(15.82±7.29)mmol/dL, (17.84±5.94)mmol/dL), and exhibited lower oxygenation level in right PL during the second category((16.16±6.56)mmol/dL, (17.60±5.84)mmol/dL) (all P<0.05). Oxygenation levels in the right DLPFC during the first temporal category ( β=0.44, t=2.52, P=0.018), in the left DLPFC during the second temporal category( β=-0.47, t=-2.82, P=0.009), and in the right PL during the second temporal category( β=-0.46, t=-2.78, P=0.010) were influencing factors for the PSQI score. Conclusions:The bilateral TLs and right PL in drug-naive PI patients exhibit phase-specific abnormalities in oxygen metabolism, potentially attributable to the insomnia-induced dysregulation of endogenous neural oscillations. The oxygen concentration changes in bilateral DLPFCs and right TL are associated with insomnia symptoms.