摘要目的:研究可能血管源性脑白质高信号（WMH）患者的脑区体素镜像同伦连接（VMHC）、联合环路连接及白质微结构的改变，分析WMH患者认知功能损害的病变基础。方法:前瞻性纳入南京医科大学附属江苏盛泽医院神经内科自2023年1月至2024年9月收治的75例WMH患者（WMH组）及同期招募的67例无明显脑部疾病的志愿者（对照组），比较2组受试者一般资料及简易精神状态检查表（MMSE）、额叶评定量表（FAB）、连线测试（TMT）等神经心理学量表评分。采集所有受试者静息态功能MRI（rs-fMRI）及弥散张量成像（DTI）数据。rs-fMRI数据通过VMHC算法分析，计算得到2组受试者VMHC值存在差异的脑区，并将其作为种子点与全脑进行功能连接，进一步将差异脑区VMHC值、功能连接值与神经心理学量表评分做Pearson相关性分析。DTI数据使用基于纤维束的空间统计（TBSS）方法进行处理，计算得到2组受试者纤维束弥散参数存在差异的脑区，并将差异脑区纤维束的弥散参数与神经心理学量表评分做Pearson相关性分析。结果:（1）一般资料及神经心理学量表评分比较：2组受试者中存在高血压病史的患者比例差异有统计学意义（ P<0.05）；WMH组患者TMT-A、TMT-B、Stroop C量表评分明显高于对照组，差异有统计学意义（ P<0.05）。（2）VMHC值及种子点功能连接值比较：与对照组相比，WMH组两侧枕中回、视觉皮层、枕颞内侧回、岛叶、中央后回的VMHC值较低，差异均有统计学意义（ P<0.05）。与对照组相比，WMH组右侧视觉皮层与右侧颞中回、两侧楔前叶、右侧背外侧额上回功能连接值减弱，右侧中央后回与右侧枕颞内侧回、左侧颞中回、左侧视觉皮层、左侧中央后回功能连接值减弱，差异均有统计学意义（ P<0.05）。WMH组两侧岛叶的VMHC值与TMT-B评分呈负相关关系（ r=-0.381， P<0.001），WMH组右侧视觉皮层与右侧背外侧额上回的功能连接值与Stroop C评分呈负相关关系（ r=-0.401， P<0.001）。（3）TBSS分析结果：2组受试者前放射冠、上放射冠、胼胝体、上纵束、丘脑后辐射的弥散参数差异有统计学意义（ P<0.05）。WMH组胼胝体膝部的各向异性分数与Stroop C评分呈正相关关系（ r=0.426， P<0.001），径向扩散系数与Stroop C评分呈负相关关系（ r=-0.376， P<0.001）；WMH组左前放射冠的平均扩散率与TMT-A评分呈负相关关系（ r=-0.443， P<0.001）。 结论:WMH患者存在同伦脑区协同性下降以及联合环路功能连接减弱，白质微结构损伤分布广泛，这些改变共同参与了WMH患者认知功能损害过程。

abstractsObjective:To investigate the alterations in voxel-mirrored homotopic connectivity (VMHC) of brain regions, association loop connectivity, and white matter microstructure in patients with white matter hyperintensities (WMH) of presumed vascular origin, and analyze the pathological basis of cognitive impairment in WMH patients.Methods:A prospective study was performed; 75 WMH patients (WMH group) admitted to Jiangsu Shengze Hospital Affiliated to Nanjing Medical University from January 2023 to September 2024 and 67 volunteers without obvious brain diseases (control group) recruited during the same period were enrolled. General data of these participants, and scores of neuropsychological scales such as mini-mental state examination (MMSE), frontal assessment battery (FAB), and trail making test (TMT) were compared between the two groups. Resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI) data of all participants were collected; rs-fMRI data were then analyzed using VMHC algorithm to calculate and conform the brain regions with significantly different VMHC between the two groups, and these regions were used as seed points to perform functional connectivity with the whole brain; Pearson correlation analyses of VMHC and functional connectivity in these brain regions with scores of neuropsychological scales were performed. DTI data were processed using tract-based spatial statistics (TBSS) method to calculate and conform the brain regions with significantly different diffusion parameters of fiber tracts between the two groups; Pearson correlation analyses of diffusion parameters of the fiber tracts in these brain regions with scores of neuropsychological scales were performed.Results:(1) Comparison of general data and neuropsychological scale scores: proportion of participants with hypertension history was significantly different between the two groups ( P<0.05); scores of TMT-A, TMT-B, and Stroop C scales in the WMH group were significantly higher than those in the control group ( P<0.05). (2) Comparison of VMHC and seed point functional connectivity: compared with that in the control group, the VMHC in bilateral middle occipital gyrus, visual cortex, medial occipitotemporal gyrus, insula, and postcentral gyrus of the WMH group were statistically lower ( P<0.05). Compared with that in the control group, functional connectivity of right visual cortex with right middle temporal gyrus, bilateral precuneus, and right dorsolateral superior frontal gyrus in the WMH group was significantly weakened, and functional connectivity of right postcentral gyrus with right medial occipitotemporal gyrus, left middle temporal gyrus, left visual cortex, and left postcentral gyrus was statistically weakened ( P<0.05). In the WMH group, the VMHC of bilateral insula was negatively correlated with TMT-B score ( r=-0.381, P<0.001), and functional connectivity between right visual cortex and right dorsolateral superior frontal gyrus was negatively correlated with Stroop C score ( r=-0.401, P<0.001). (3) TBSS results: the diffusion parameters of the anterior corona radiata, superior corona radiata, corpus callosum, superior longitudinal fasciculus, and posterior thalamic radiation were statistically significant between the two groups ( P<0.05). In the WMH group, the fractional anisotropy in the genu of the corpus callosum was positively correlated with Stroop C score ( r=0.426, P<0.001), radial diffusivity was negatively correlated with Stroop C score ( r=-0.376, P<0.001), and mean diffusivity of the left anterior corona radiata was negatively correlated with TMT-A score ( r=-0.443, P<0.001). Conclusion:WMH patients have decreased coordination in homotopic brain regions and weakened functional connectivity of association loops, with widely distributed white matter microstructure damages, which may be involved in the neuropathological process of cognitive impairment.