抗N-甲基-D-天冬氨酸受体脑炎患者长程联合纤维的改变。

Alterations of long-range association fibers in patients with anti-N-methyl-D-aspartate receptor encephalitis.

作者信息

Chen Xiaodong, Fang Ling, Huang Yiying, Huang Yu, Lu Yi, Wang Jinhui, Liu Chunxin, Liao Huanquan, Zhou Liemin, Qiu Wei, Shu Yaqing

机构信息

Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, No. 628, Zhenyuan Road, Guangming District, Shenzhen 518106 Guangdong, China; Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou 510630 Guangdong, China.

Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou 510630 Guangdong, China.

出版信息

Neuroimage Clin. 2025 May 24;47:103808. doi: 10.1016/j.nicl.2025.103808.

DOI:10.1016/j.nicl.2025.103808

PMID:40440891

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12158604/

Abstract

BACKGROUND

Patients with anti-NMDAR encephalitis typically exhibit impaired cognitive integration, which relies on the integrity of long-range association fibers connecting diverse brain regions. However, the microstructural integrity of long-range association fibers in this population remains unknown.

METHODS

Diffusion tensor imaging (DTI) data were collected from 32 patients with anti-NMDAR encephalitis and 30 healthy controls. Patients were further categorized into early and delayed immunotherapy subgroups based on a 2-week threshold for immunotherapy initiation. The diffusion properties of major long-range association fibers were quantified at both the bundle and node levels.

RESULTS

Compared with healthy controls, patients exhibited widespread microstructural damage within long-range association fibers, with more severe alterations in the delayed immunotherapy subgroup (FDR-corrected p < 0.05). In this subgroup(n = 14), radial diffusivity (RD) of left inferior fronto-occipital fasciculus (IFOF), left inferior longitudinal fasciculus (ILF), left superior longitudinal fascicles (SLF), and bilateral arcuate fascicles correlated significantly with global cognition (MMSE, FDR-corrected p < 0.05). Notably, RD also strongly correlated with working memory in the delayed immunotherapy subgroup, showing bundle-wise associations for IFOF (left: r = -0.8315, p = 0.0112; right: r = -0.7044, p = 0.0295), ILF (left: r = -0.7473, p = 0.0243), SLF (left: r = -0.7562, p = 0.0243; right: r = -0.6599, p = 0.0391), and arcuate fasciculus (left: r = -0.7240, p = 0.0272; right: r = -0.6835, p = 0.0333), with left-hemisphere predominance confirmed by node-wise analyses of IFOF, ILF, SLF, and arcuate fasciculus (FDR-corrected p < 0.05).

CONCLUSIONS

Our findings highlight widespread microstructural damage in long-range association fibers in patients with anti-NMDAR encephalitis, particularly in those with delayed immunotherapy. This damage may serve as the neurophysiological basis for cognitive impairments, with working memory being most affected.

摘要

背景

抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者通常表现出认知整合受损，这依赖于连接不同脑区的长程联合纤维的完整性。然而，该人群中长程联合纤维的微观结构完整性仍不清楚。

方法

收集了32例抗NMDAR脑炎患者和30名健康对照者的扩散张量成像（DTI）数据。根据免疫治疗开始的2周阈值，将患者进一步分为早期和延迟免疫治疗亚组。在束和节点水平上对主要长程联合纤维的扩散特性进行了量化。

结果

与健康对照相比，患者在长程联合纤维中表现出广泛的微观结构损伤，延迟免疫治疗亚组的改变更为严重（错误发现率校正p<0.05）。在该亚组（n = 14）中，左侧额枕下束（IFOF）、左侧下纵束（ILF）、左侧上纵束（SLF）和双侧弓状束的径向扩散率（RD）与整体认知显著相关（简易精神状态检查表，错误发现率校正p<0.05）。值得注意的是，RD在延迟免疫治疗亚组中也与工作记忆密切相关，显示出IFOF（左侧：r = -0.8315，p = 0.0112；右侧：r = -0.7044，p = 0.0295）、ILF（左侧：r = -0.7473，p = 0.0243）、SLF（左侧：r = -0.7562，p = 0.0243；右侧：r = -0.6599，p = 0.0391）和弓状束（左侧：r = -0.7240，p = 0.0272；右侧：r = -0.6835，p = 0.0333）的束状关联，通过对IFOF、ILF、SLF和弓状束的节点分析证实了左半球优势（错误发现率校正p<0.05）。