School of Rehabilitation, Kunming Medical University, Yunnan, China.
Department of Rehabilitation Medicine Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Neural Plast. 2021 Feb 1;2021:8815144. doi: 10.1155/2021/8815144. eCollection 2021.
This study is aimed at investigating brain structural changes and structural network properties in complete spinal cord injury (SCI) patients, as well as their relationship with clinical variables.
Structural MRI of brain was acquired in 24 complete thoracic SCI patients (38.50 ± 11.19 years, 22 males) within the first postinjury year, while 26 age- and gender-matched healthy participants (38.38 ± 10.63 years, 24 males) were enrolled as control. The voxel-based morphometry (VBM) approach and graph theoretical network analysis based on cross-subject grey matter volume- (GMV-) based structural covariance networks (SCNs) were conducted to investigate the impact of SCI on brain structure. Partial correlation analysis was performed to explore the relationship between the GMV of structurally changed brain regions and SCI patients' clinical variables, including injury duration, injury level, Visual Analog Scale (VAS), American Spinal Injury Association Impairment Scale (AIS), International Classification of Functioning, Disability and Health (ICF) scale, Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS), after removing the effects of age and gender.
Compared with healthy controls, SCI patients showed higher SDS score ( = 4.392 and < 0.001). In the VBM analysis, significant GMV reduction was found in the left middle frontal cortex, right superior orbital frontal cortex (OFC), and left inferior OFC. No significant difference was found in global network properties between SCI patients and healthy controls. In the regional network properties, significantly higher betweenness centrality () was noted in the right anterior cingulum cortex (ACC) and left inferior OFC and higher nodal degree and efficiency in bilateral middle OFCs, while decreased was noted in the right putamen in SCI patients. Only negative correlation was found between GMV of right middle OFC and SDS score in SCI patients ( = -0.503 and = 0.017), while no significant correlation between other abnormal brain regions and any of the clinical variables (all > 0.05).
SCI patients would experience depressive and/or anxious feelings at the early stage. Their GMV reduction mainly involved psychology-cognition related rather than sensorimotor brain regions. The efficiency of regional information transmission in psychology-cognition regions increased. Greater GMV reduction in psychology region was related with more severe depressive feelings. Therefore, early neuropsychological intervention is suggested to prevent psychological and cognitive dysfunction as well as irreversible brain structure damage.
本研究旨在探讨完全性脊髓损伤（SCI）患者的脑结构变化和结构网络特性，及其与临床变量的关系。
在损伤后 1 年内，对 24 例完全性胸段 SCI 患者（38.50±11.19 岁，22 名男性）进行脑结构 MRI 检查，同时纳入 26 名年龄和性别匹配的健康对照者（38.38±10.63 岁，24 名男性）。采用基于体素的形态学（VBM）方法和基于跨被试灰质体积（GMV）的结构协方差网络（SCN）的图论网络分析，探讨 SCI 对脑结构的影响。采用偏相关分析，在控制年龄和性别影响后，探讨结构改变脑区的 GMV 与 SCI 患者临床变量（损伤持续时间、损伤水平、视觉模拟量表（VAS）评分、美国脊髓损伤协会损伤分级（AIS）、国际功能、残疾和健康分类（ICF）量表、抑郁自评量表（SDS）评分、焦虑自评量表（SAS）评分）之间的关系。
与健康对照组相比，SCI 患者 SDS 评分较高（=4.392，P<0.001）。VBM 分析显示，SCI 患者左侧额中回、右侧额上回和左侧额下回 GMV 减少。SCI 患者和健康对照组的全脑网络特性无显著差异。在区域网络特性方面，SCI 患者右侧前扣带回皮质（ACC）和左侧额下回的介数中心度（）较高，双侧额中回的节点度和效率较高，右侧壳核的效率较低。仅在 SCI 患者中，右侧额中回 GMV 与 SDS 评分呈负相关（= -0.503，P=0.017），而其他异常脑区与任何临床变量均无显著相关性（均 P>0.05）。
SCI 患者在早期会出现抑郁和/或焦虑情绪。其 GMV 减少主要涉及心理认知相关脑区，而心理认知相关脑区的区域信息传递效率增加。心理区域 GMV 减少越多，抑郁情绪越严重。因此，建议早期进行神经心理干预，以预防心理和认知功能障碍及不可逆的脑结构损伤。
