多发性硬化网络节点改变的基于体素度中心度的fMRI研究

目的：利用度中心度（DC）探索复发缓解型多发性硬化（RRMS）患者脑网络的功能异常。方法：选择26例RRMS患者为RRMS组，27例性别、年龄匹配的正常人为对照组。所有患者完成扩展残疾状况评分量表（EDSS）。DC和功能连接方法评估RRMS的脑功能改变。Pearson相关评估差异脑区与行为学的相关性。ROC曲线评估差异脑区对2组的区分能力。结果：DC差异不随相关系数r值的不同而变化。相比对照组，RRMS组DC值增加脑区主要包括右侧小脑后叶、左侧枕中回、左侧背侧前额叶和双侧顶上小叶，减低脑区主要包括左侧扣带回和双侧颞极突入岛叶。ROC曲线显示这些脑区能较好的区分2组（AUC=0.943，敏感度为96.3%，特异度为88.5%）。在RRMS组，病程与左侧颞极呈负相关（r=-0.483，P=0.020），EDSS得分与右侧顶上小叶呈正相关（r=0.485，P=0.019），与右侧颞极呈负相关（r=-0.430，P=0.041）。功能连接显示DC减低的颞极和扣带回存在网络间和网络内的功能连接减低。结论：扣带回和颞极在RRMS患者中存在功能异常，这些关键网络节点可以预测疾病进展和残疾状态。

An fMRI study of network node changes in relapsing-remitting multiple sclerosis based on voxel centrality

Objective: To explore the abnormal alteration of intrinsic functional hubs and their relationship with the clinical features in relapsing-remitting multiple sclerosis (RRMS) using degree centrality approach. Methods: A total of 26 RRMS and 27 status-matched healthy groups were recruited. RRMS patients underwent a physical examination using Expanded Disability Status Scale (EDSS) by an experienced neurologist. Degree centrality and functional connectivity methods were used to evaluate the features of abnormal intrinsic functional hubs. Pearson correlation analysis was conducted to investigate the relationship between clinical features and abnormal functional hubs. Receiver operating characteristic (ROC) curve was applied to calculate the sensitivity and specificity of those altered functional hubs in distinguishing the RRMS from the HGs. Results: The covered brain areas of degree centrality differences didn’t change with different thresholds of correlation coefficient r values. Compared with the HGs, the RRMS demonstrated significantly higher degree centrality values in multiple brain areas and lower degree centrality values in bilateral salience network and left cingulate gyrus. Decreased functional connectivity was found within the left-right salience network, and between the salience network and the cingulate gyrus. Disease duration of RRMS revealed a negative linear correlation with the degree centrality value in the left temporal pole (r=-0.483, P=0.020). EDSS revealed a positive linear correlation with the degree centrality value in the right superior parietal lobule (r=0.485, P=0.019), and a negative linear correlation with the degree centrality value in the right temporal pole (r=-0.430, P=0.041). ROC analysis showed good performance of these abnormal hubs in distinguishing the RRMS from the HGs (AUC=0.943, sensitivity was 96.3%, specificity was 88.5%). Conclusion: The functional deficits in the cingulate gyrus and temporal pole in RRMS could predict disease progression and disability status, which may expand our understanding of functional characteristics and provide a new insight into the pathophysiological mechanism of RRMS.