基于核磁共振成像技术的甲状腺功能减退伴焦虑患者的脑功能区研究

目的 探讨甲状腺功能减退伴焦虑患者脑功能区核磁共振成像(Magnetic resonance imaging,MRI)表现。方法 选取本院2018年5月-2019年8月收治的甲状腺功能减退伴焦虑患者30例为观察组,并选取同期体检健康者30例为对照组; 收集2组研究对象的一般资料,并对脑功能区进行功能磁共振成像(Functional magnetic resonance imaging,fMRI)扫描,采用局部一致性(Regional homogeneity,ReHo)值找出基础状态下自发异常脑功能活动区,Speaeman分析异常脑功能区与甲状腺激素水平、神经精神症状的相关性。结果 fMRI扫描显示甲状腺功能减退患者右海马旁回、左侧颞下回、左右前扣带回脑功能区的ReHo值明显高于对照组(0.81±0.02 vs. 0.78±0.04、0.73±0.07 vs. 0.69±0.05、0.89±0.12 vs.0.84±0.09、0.87±0.11 vs. 0.83±0.07)(P<0.05),左侧内额上回ReHo值明显低于对照组(0.77±0.13 vs. 0.72±0.11)(P<0.05); 不同焦虑程度的右海马旁回、左侧颞下回、左前扣带回、右前扣带回、左侧内侧额上回5个异常脑功能区ReHo值相近(P>0.05); 左、右前扣带回ReHo值与游离甲状腺素(Free thyroxine,FT4)水平显著相关(r=-0.398,P=0.023; r=-0.424,P=0.031); 左、右前扣带回ReHo值与焦虑等级显著相关(r=0.425,P=0.533; r=0.027,P=0.017)。结论 海马旁回、颞下回、前扣带回、内侧额上回4个脑功能区可能参与甲状腺功能减退患者引发焦虑症状的脑部生理机制,甲状腺功能减退患者焦虑症状的脑神经反常活动与前扣带回自发异常活动密切相关,可为甲状腺功能减退伴焦虑患者的临床诊疗提供新思路。

MRI-based study of brain functional areas in patients with hypothyroidism and anxiety

ObjectiveTo explore the magnetic resonance imaging(MRI)manifestations of brain functional areas in patients with hypothyroidism and anxiety.Methods Between May 2018 and August 2019, we enrolled 30 patients with hypothyroidism and anxiety and 30 healthy subjects. The demographic data of the two groups were collected. Brain functional MRI(fMRI)was performed. The spontaneous abnormal brain function areas under the basic state were identified by regional homogeneity(ReHo)value. The correlation between abnormal brain function areas and neuropsychiatric symptoms and thyroid hormone was analyzed by Spearman’s correlation coefficient.Results fMRI scanning showed that the ReHo values of the functional areas of the right hippocampus, left temporal inferior gyrus, and left and right anterior cingulgyrgyrus were higher than those in the control group(0.81±0.02 vs. 0.78±0.04, 0.73±0.07 vs. 0.69±0.05, 0.89±0.12 vs. 0.84±0.09, 0.87±0.11 vs. 0.83±0.07, respectively)(P<0.05). ReHo value in the left lateral frontal superior gyrus is significantly lower than that of normal subjects(0.77±0.13 vs. 0.72±0.11)(P<0.05). The ReHo values of the five brain functional areas including the right parahippocampal gyrus, left inferior temporal gyrus, left anterior cingulate gyrus, right anterior cingulate gyrus, and left medial superior frontal gyrus were similar in patients with different degrees of anxiety(P>0.05). The ReHo values in the left and right anterior cingulate gyrus were correlated with free thyroxine(FT4)(r=-0.398, P=0.023; r=-0.424, P=0.031). The ReHo values in the left and right anterior cingulate gyrus were correlated with anxiety level(r=0.425, P=0.533; r=0.027, P=0.017).Conclusion Parahippocampal gyrus, inferior temporal gyrus, anterior cingulate gyrus, and medial superior frontal gyrus may participate in the pathogenesis of anxiety in patients with hypothyroidism. The abnormal activities of the brain in patients with hypothyroidism are closely related to the spontaneous abnormal activities of the anterior cingulate cortex. Our results provide new evidence for clinical diagnosis and treatment of patients with hypothyroidism and anxiety.