非神经精神性系统性红斑狼疮患者的空间工作记忆损害：一项基于血氧水平依赖性功能磁共振成像的研究
Spatial Working Memory Impairment in Patients with Non-neuropsychiatric Systemic Lupus Erythematosus: A Blood-oxygen-level Dependent Functional Magnetic Resonance Imaging Study.
作者信息
Zhu Chun-Min, Ma Ye, Xie Lei, Huang Jin-Zhuang, Sun Zong-Bo, Duan Shou-Xing, Lin Zhi-Rong, Yin Jing-Jing, Le Hong-Bo, Sun Dan-Miao, Xu Wen-Can, Ma Shu-Hua
机构信息
From the Department of Radiology, First Affiliated Hospital, Medical College of Shantou University; Guangdong Key Laboratory of Medical Molecular Imaging, Shantou, Guangdong; Graduate School of Beijing Normal University, Zhuhai, China.
C.M. Zhu, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; L. Xie, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.Z. Huang, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; Z.B. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Department of Radiology, Chaonan Minsheng Hospital of Shantou; S.X. Duan, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; Z.R. Lin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; J.J. Yin, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; H.B. Le, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; D.M. Sun, MD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging; S.H. Ma, PhD, Professor, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University, and Guangdong Key Laboratory of Medical Molecular Imaging, and Chaonan Minsheng Hospital of Shantou; Y. Ma, MD, Graduate School of Beijing Normal University; W.C. Xu, PhD, Department of Radiology, First Affiliated Hospital, Medical College of Shantou University.
出版信息
J Rheumatol. 2017 Feb;44(2):201-208. doi: 10.3899/jrheum.160290. Epub 2017 Jan 15.
OBJECTIVE
Using ethology and functional magnetic resonance imaging (fMRI) to explore mild cognitive dysfunction and spatial working memory (WM) impairment in patients with systemic lupus erythematosus (SLE) without overt neuropsychiatric symptoms (non-NPSLE) and to study whether any clinical biomarkers could serve as predictors of brain dysfunction in this disease.
METHODS
Eighteen non-NPSLE patients and 18 matched subjects were all tested using the Montreal cognitive assessment scale test and scanned using blood-oxygen-level dependent fMRI while performing the n-back task to investigate the activation intensity of some cognition-related areas.
RESULTS
Ethology results showed that non-NPSLE patients had mild cognitive dysfunction and memory dysfunction (p < 0.05). The fMRI scan confirmed a neural network consisting of bilateral dorsolateral prefrontal cortex (DLPFC), premotor area, parietal lobe, and supplementary motor area (SMA)/anterior cingulate cortex (ACC) that was activated during the n-back task, with right hemisphere dominance. However, only the right SMA/ACC showed a load effect in the non-NPSLE group; the activation intensity of most WM-related brain areas for the non-NPSLE group was lower than for the control group under 3 memory loads. Further, we found that the activation intensity of some cognition-related areas, including the bilateral caudate nucleus/insula and hippocampus/parahippocampal gyrus were lower than the control group under the memory loads. An inverse correlation existed between individual activation intensity and disease duration.
CONCLUSION
Non-NPSLE-related brain damage with right DLPFC-posterior parietal lobe and parahippocampal gyrus default network causes impairment of spatial WM and mild cognitive dysfunction. Patients with longer disease duration would be expected to exhibit increased central nervous system damage.
目的
运用行为学和功能磁共振成像（fMRI）技术，探究无明显神经精神症状的系统性红斑狼疮（SLE）患者（非神经精神性狼疮，non-NPSLE）的轻度认知功能障碍和空间工作记忆（WM）损害情况，并研究是否有临床生物标志物可作为该疾病脑功能障碍的预测指标。
方法
对18例非神经精神性狼疮患者和18例匹配的受试者进行蒙特利尔认知评估量表测试，并在执行n-back任务时采用血氧水平依赖性功能磁共振成像进行扫描，以研究一些认知相关区域的激活强度。
结果
行为学结果显示，非神经精神性狼疮患者存在轻度认知功能障碍和记忆功能障碍（p<0.05）。功能磁共振成像扫描证实，在n-back任务期间，由双侧背外侧前额叶皮质（DLPFC）、运动前区、顶叶和辅助运动区（SMA）/前扣带回皮质（ACC）组成的神经网络被激活，且以右侧半球为主导。然而，在非神经精神性狼疮组中，仅右侧SMA/ACC显示出负荷效应；在3种记忆负荷下，非神经精神性狼疮组大多数与工作记忆相关的脑区激活强度低于对照组。此外，我们发现，在记忆负荷下，包括双侧尾状核/岛叶和海马/海马旁回在内的一些认知相关区域的激活强度低于对照组。个体激活强度与病程呈负相关。
结论
与非神经精神性狼疮相关的脑损伤累及右侧背外侧前额叶皮质-顶叶后部和海马旁回默认网络，导致空间工作记忆损害和轻度认知功能障碍。病程较长的患者中枢神经系统损伤可能会加重。
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