夜间遗尿症儿童脑网络频率依赖性度中心性特征

目的 在不同频段探索夜间遗尿症(NE)儿童脑网络信号传递特点,找到异常脑区,为后续精准治疗提供理论依据。方法 采用病例对照研究,根据国际儿童尿控协会(ICCS)的标准入组2016—2018年上海儿童医学中心就诊的129名NE患儿和37名正常儿童。在经典频段(0.01~0.08 Hz)和频段5(0.010~0.027 Hz)分析两组儿童度中心性(DC)特点,并采用t检验比较不同频段下的两组差异性。使用高斯随机场(GRF)理论对结果进行校正(体素P<0.05,团块P<0.05)。结果 在典型频段中,NE患儿在左侧中央沟盖(t=4.469 9,GRF矫正体素 P<0.05,团块P<0.05)、右侧中央沟盖(t=4.351 6,GRF矫正体素 P<0.05,团块P<0.05)、内侧和旁扣带回(t=4.139 7,GRF矫正体素 P<0.05,团块P<0.05) DC显著升高,右侧回直肌(t=-4.127 2,GRF矫正体素 P<0.05,团块P<0.05)和左侧额中回中DC降低(t=-4.835 5,GRF矫正体素 P<0.05,团块P<0.05)。在子频段中,左侧丘脑DC值升高(t=3.905 4,GRF矫正体素 P<0.05,团块P<0.05),右侧眶部额上回DC值降低(t=-4.509 6,GRF矫正体素 P<0.05,团块P<0.05)。结论 频段5中DC值异常的脑区与儿童排尿功能的调节直接相关,经典频段中的脑区功能还有待进一步研究。左侧丘脑DC值的增加和额中回的DC值降低,可能影响儿童排尿网络的信息传递,造成夜间遗尿的发生。

Frequency-dependent changes in the degree centrality in children with nocturnal enuresis

Objective To explore the characteristics of brain network signal transmission in children with nocturnal enuresis (NE) in different frequency bands, and to find abnormal brain areas, so as to provide theoretical basis for follow-up precision treatment. Methods A case-control study was adopted. According to the criteria of the International Children′s Continence Society (ICCS), 129 children with NE and 37 children without enuresis in Shanghai Children′s Medical Center were enrolled in this study from 2016 to 2018. Degree centrality (DC) was analyzed in the typical band (0.01-0.08 Hz) and in slow 5 (0.010-0.027 Hz). T test were used to compare the differences between the two groups in the different frequency bands. Results were corrected using Gaussian random field (GRF) theory (P<0.05 for voxels and P<0.05 for clusters). Results In the typical frequency band, children with enuresis had significantly higher DCs in the left rolandic operculum (t=4.469 9, GRF corrected P<0.05 for voxel, P<0.05 for clusters), right rolandic operculum(t=4.351 6, GRF corrected P<0.05 for voxel, P<0.05 for clusters) and left middle cingulate gyrus (t=4.139 7, GRF corrected P<0.05 for voxel, P<0.05 for clusters), while lower DCs in the right gyrus rectus (t＝-4.127 2, GRF corrected P<0.05 for voxel, P<0.05 for clusters) and the left middle frontal gyrus (t＝-4.835 5, GRF corrected P<0.05 for voxel, P<0.05 for clusters). In sub-bands, DC values of children with nocturnal enuresis were increased in the left thalamus (t=3.905 4, GRF corrected P<0.05 for voxel, P<0.05 for clusters) and decreased in the right superior frontal gyrus, orbital part (t＝-4.509 6, GRF corrected P<0.05 for voxel, P<0.05 for clusters). Conclusions Brain regions with abnormal DC values in band 5 are directly related to the regulation of voiding function in children, according to previous study. And the function of brain regions in the typical band needs to be further investigated. Increased DC values in the left thalamus and decreased DC values in the frontal middle gyrus may affect the transmission of information in the voiding network of children, which may contribute to the occurrence of nocturnal enuresis.