青少年肌阵挛癫及其网络连接研究进展

孙 伟



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孙 伟

青少年肌阵挛性癫；脑结构网络；功能网络

大脑是生物体内结构和功能最复杂的器官，同时它也是极为精巧和完善的信息处理系统。10年前，学者们提出了“脑网络”的概念。“脑网络”主要基于实验测量的反映大脑结构性连接的数据，或大脑功能性连接的数据，计算预先定义的脑区或节点的连接关系，然后构建网络进行分析，这是目前应用最多的一类“脑网络”研究方法。

近年来，越来越多的研究证实，JME患者的脑结构网络和功能网络(包括静息态网络和认知网络等)连接均受到了影响。下面笔者通过对JME相关网络的结构连接及功能连接方面的研究做进一步的综述，以期对近年来JME网络连接进展有更深入的了解。

1 JME患者脑结构及结构网络连接改变

常规磁共振成像(magnetic resonance imaging,MRI)和CT(computered tomography,CT)检查通常不能发现JME患者大脑结构上微小的变化。近年来，随着影像学技术的发展，许多学者通过基于体素形态学分析(voxel-based morphometry,VBM)和弥散张量成像(diffusion tensor imaging,DTI)等技术发现了JME患者大脑的局部结构异常,且异常部位主要集中在额叶结构。VBM是一种基于体素的针对脑组织结构的形态学测量方法，它通过计算磁共振成像(主要是高分辨率的结构扫描图像)中脑的灰质/白质的变化，以定量分析不同群体脑结构的特征和脑组织成分的差异，从而替代了传统上人工勾画感兴趣区域的方法，提高了测量的准确性和可重复性，能够准确、全面评价不同群体脑的神经解剖变化。1999年, Woermann等[12]应用VBM方法首先发现额中回灰质密度发生变化，为JME患者脑局部结构变化提供了依据。Pulsipher等[13]发现，JME患者的丘脑和额叶体积变小。Tae和Betting等[14,15]应用VBM证实了JME患者额叶灰质密度的减少。Kim等[16]发现，JME患者丘脑灰质密度与病程呈负相关关系，并提出JME患者可能有丘脑进行性神经元缺失。

2 JME患者脑功能及功能网络连接改变

除了上述提到的应用较多的VBM、DTI及fMRI手段外，学者们还通过磁共振波谱成像(magnetic resonance spectroscopy, MRS)，正电子发射断层显像(positron emission tomography, PET)及经颅磁刺激(transcranial magnetic stimulation，TMS)等技术研究JME患者的脑网络连接变化。Lin等[30]通过MRS发现额中前皮质、初级运动区以及丘脑N-乙酰天门冬氨酸与肌酐的比值(神经元受损的标志)下降；额中前皮层、初级运动区及后扣带回皮质谷氨酸/谷氨酰胺与肌酐的比值减低，说明了广泛的大脑皮质兴奋性降低。Swartz等[31]通过PET发现背外侧前额皮质、运动前区的氟代脱氧葡萄糖减少。同样，利用PET技术，Meschaks等[32]发现JME患者中缝核、海马、背外侧前额皮质的5-羟色胺受体减少。Akgun等[33]通过TMS证实JME患者的运动区皮质兴奋性增加。国内侯文生等[34]也运用同样的方法证实了该结论。

3 小结与展望

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(2017-04-10收稿 2017-05-05修回)

(责任编辑 梁秋野)

国家自然科学基金(81571267)

孙 伟，博士，主任医师，教授，博士生导师。

100053 北京，首都医科大学宣武医院神经内科

R742.1