摘要目的 采用功能磁共振成像技术对特发性快速眼球运动睡眠行为障碍(iRBD)患者快速眼球运动期(REM)睡眠调控核心区进行全脑功能连接,探讨iRBD患者上述脑区是否存在功能连接异常.方法 根据入选标准,纳入2014-2017年于郑州大学人民医院神经内科就诊的iRBD患者20例(iRBD组)、正常对照者21名,采用Hoehn-Yahr分期量表和认知量表对受试者进行运动认知功能评估,并对两组行静息态功能磁共振扫描结果进行比较.结果 iRBD组Hoehn-Yahr分期[0(0,0)期]与正常对照组[0(0,0)期,Z=-1.820,P=0.069]相比差异无统计学意义;听觉词语学习测验(AVLT) N1[(3.80±1.67)分]、AVLT N2[(5.10±1.77)分]、符号数字模式测验[SDMT,22.00(20.25,26.00)分]、Rey-Osterrieth复杂图形测验(ROCFT) [33.00(31.25,34.00)分]低于正常对照组[分别为(4.95±1.28)分,t=2.482,P=0.017;(6.43±1.16)分,t=2.848,P=0.007;33.00(29.50,35.50)分,Z=-3.792,P=0.000;35.00 (33.00,36.00)分,Z=-2.351,P=0.019]且差异有统计学意义;连线测验1 [86.5(70.0,100.0)分]、连线测验2[197.0(180.5,211.5)分]评分高于正常对照组[66.0(49.0,91.5)分,Z=-2.373,P=0.018;112.0(99.5,173.0)分,Z=-3.105,P =0.002]且差异有统计学意义.与正常对照组比较,iRBD组右侧蓝斑下核与双侧扣带回(t=-4.173)、双侧额叶[t=-2.965(左侧)、-3.662(右侧)]功能连接减弱;左侧蓝斑下核与全脑功能连接与正常对照组比较差异无统计学意义;中脑导水管周围灰质(vlPAG)与左侧中央前回和中央后回功能连接增强(t =3.930),与右侧额叶功能连接增强(t=4.141).结论 iRBD的睡眠调控核心区域与扣带回、额顶叶皮质功能连接存在异常,可能引起iRBD患者出现认知及运动功能障碍.

abstractsObjective To investigate the abnormal functional connectivity (FC) between the cores (including sublaterodorsal nucleus (SLD) and ventrolateral periaqueductal gray matter (vlPAG)) and the whole brain in rapid eye movement sleep behavior disorder (RBD) by resting state functional magnetic resonance imaging (rfMRI).Methods A total of 41 subjects recruited in the Department of Neurology,the People's Hospital of Zhengzhou University were enrolled in this study according to international diagnosis criteria,including 20 with idiopathic RBD (iRBD group) and 21 age,sex-matched normal controls (control group).All subjects were examined by Hoehn-Yahr Staging,cognitive tests and rfMRI.Resluts HoehnYahr staging score was 0(0,0) in the iRBD group,which showed no significant difference from that in the control group (0 (0,0),Z =-1.820,P =0.069).The scores of Rey Auditory Verbal Learning Test (AVLT) N1,AVLT N2,Symbol Digital Modalities Test,Rey-Osterrieth Complex Figure Test-Copy were 3.80 ± 1.67,5.10 ± 1.77,33.00(31.25,34.00) and 22.00(20.25,26.00) respectively in the iRBD group,which were significantly lower than that in the control group (4.95 ± 1.28,t =2.482,P =0.017;6.43±1.16,t =2.848,P=0.007;33.00(29.50,35.50),Z=-3.792,P=0.000;35.00(33.00,36.00),Z =-2.351,P =0.019) respectively.The scores of Trail Making Test 1 (86.5 (70.0,100.0))and Trail Making Test 2 (197.0(180.5,211.5)) in the iRBD group were significantly higher than that in the control group (66.0(49.0,91.5),112.0(99.5,173.0) respectively,Z=-2.373,P=0.018;Z =-3.105,P =0.002).Compared with the control group,the FC analysis showed reduced connections from the right SLD to the bilateral cingnlate gyrus (t =-4.173) and bilateral frontal gyrus (t =-2.965(left),-3.662(right)),from the vlPAG to the left precentral-postcentral gyrus(t =3.930),and from the vlPAG to the right frontal gyrus (t =4.141) in the iRBD.There was no statistically significant difference from the left SLD to the whole brain.Conclusion There were abnormal FCs from the SLD and vlPAG to cognitive and motor areas in RBD patients,perhaps leading to clinical RBD symptoms such as cognitive deterioration and movement disorder.