摘要目的:探讨儿童难治性癫痫（DRE）脑功能网络及结构-功能耦合改变及其与认知功能、病程和发病年龄的相关性。方法:该研究为横断面研究。前瞻性纳入2021年8月至2023年8月在遵义医科大学附属医院接受诊治的19例DRE患儿（DRE组）临床及影像资料。另收集年龄、性别相匹配的27名健康儿童为健康对照组。对所有被试者进行3D-T 1WI、T 2液体衰减反转恢复、扩散张量成像（DTI）、静息态功能磁共振（rs-fMRI）扫描和韦氏智力量表评估。采用独立样本 t检验、Mann-Whitney U检验分析2组的全局、局部拓扑属性指标及全脑和模块水平的结构-功能耦合（SFC）值。采用Spearman、Pearson相关分析来评估异常的静息态功能脑网络指标与韦氏智力量表分数（言语理解指数、知觉推理指数、工作记忆指数、加工速度指数和总智商）、病程和发病年龄的相关性。 结果:与健康对照组比较，DRE组言语理解指数、知觉推理指数、工作记忆指数、加工速度指数和总智商降低，差异均具有统计学意义（ P<0.05）。DRE组和健康对照组脑功能网络均具有小世界属性。DRE组与健康对照组左侧苍白球节点度所有稀疏度的曲线下面积值差异有统计学意义（2.998±0.942、4.992±1.945， t=-4.07，FDR校正 P<0.05）。与健康对照组比较，DRE组边缘网络（LN）内SFC降低（ P<0.05），感觉运动网络（SMN）内SFC增加（ P<0.05），默认网络-LN间SFC降低（ P<0.05），SMN-注意网络（AN）间SFC增加（ P<0.05）。2组全脑水平的SFC差异无统计学意义。相关分析显示DRE组左侧苍白球DC与加工速度指数呈负相关（ r=-0.537， P=0.018），SMN-AN间SFC与发病年龄呈负相关（ r=-0.537， P=0.018）。 结论:左侧苍白球的DC改变可能与DRE认知功能损伤有关，为儿童DRE神经机制研究提供生物标记信息。

abstractsObjective:To investigate the changes in brain functional network and structural-functional network coupling in children with drug-resistant epilepsy (DRE), and to analyze their correlation with cognitive function, disease duration, and age of onset.Methods:This study was a cross-sectional study. Clinical and imaging data of 19 children with DRE who received consultation and treatment at the Affiliated Hospital of Zunyi Medical University from August 2021 to August 2023 (DRE group) were prospectively included. Another 27 age-and sex-matched healthy children were collected as the healthy control group. All subjects had 3D-T 1WI, T 2 fluid-attenuated inversion recovery, diffusion tensor imaging (DTI), resting-state functional magnetic resonance imaging (rs-fMRI) scans and Wechsler Intelligence Scale assessments. Independent sample t-test and Mann-Whitney U test were used to analyze the global and local topological attributes, as well as the structural-functional coupling (SFC) values at the whole brain and modular levels in two groups. Correlations between abnormal resting state brain functional network indicators and the Wechsler Intelligence Scale score [verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), processing speed index (PSI), full scale intelligence quotient (FSIQ)], disease duration and age of onset was evaluated using a Spearman or Pearson correlation analysis. Results:Compared to the healthy control group, DRE group exhibited decreased VCI, PRI, WMI, PSI, FSIQ and the differences were all statistically significant (all P<0.05). Both brain functional networks had small world attributes. There was a statistically significant difference in the area under the curve of sparsity of degree centrality (DC) in the left pallidum between the DRE group and healthy control group (2.998±0.942, 4.992±1.945, t=-4.07, FDR corrected P<0.05). Compared with the control group, the DRE group had decreased SFC within the limbic network (LN) ( P<0.05), increased SFC within the sensorimotor (SMN) ( P<0.05), decreased SFC between the default mode network-LN ( P<0.05), and increased SFC between the SMN-attentional network (AN) ( P<0.05). There was no statistically significant difference in SFC at the whole brain level between the two groups. Correlation analysis indicated that DC in left pallidum in DRE group negatively correlated with the PSI ( r=-0.537, P=0.018), and SFC between the SMN and AN demonstrated a negative correlation with age of onset ( r=-0.537, P=0.018). Conclusion:The altered DC in left pallidum may be related to cognitive impairment in children with DRE, providing biomarker information for the study of neural mechanisms in children with DRE.