帕金森病冲动控制障碍患者中脑-皮质-边缘系统效应功能连接与结构连接的机制研究

Impulse control disorder (ICD) is one of the most serious non-motor symptoms of Parkinson's disease (PD). Its pathogenesis is unknown and objective biomarkers are lacking. Previous studies and our work have found that the mesocorticolimbic system (MCLS) in PD patients with ICD has dysfunction, which may be the characteristics of brain imaging in PD patients with ICD. However, it is still unknown how the core brain regions in MCLS regulate each other (i.e. effective functional connectivity) and how the brain structural connectivity and effective functional connectivity are coupled among PD patients with ICD. The purpose of this project is to analyze the brain changes of MCLS in PD patients with ICD via resting-state fMRI-based effective functional connectivity analysis and diffusion tensor imaging (DTI) technology, and to clarify whether there is abnormal effective functional connectivity, structural connectivity and their coupling of MCLS in PD patients ICD. The expected results will provide theoretical bases for revealing the neural mechanism of PD-ICD and hopefully obtain objective imaging markers for PD-ICD.

冲动控制障碍（ICD）是帕金森病（PD）最严重的非运动症状之一，其发病机制不详，且缺乏客观的生物标记物。既往研究及我们前期研究发现PD-ICD患者中脑-皮质-边缘系统（MCLS）存在功能障碍，这可能是PD-ICD患者脑影像的特征。但是，PD-ICD患者MCLS核心脑区间如何相互调控（即效应功能连接）及脑结构连接和效应功能连接间耦合性的模式却仍未知。本项目旨在利用基于静息态fMRI的效应功能连接分析手段及弥散张量成像（DTI）技术，分析PD-ICD患者MCLS的脑改变，阐明PD-ICD患者是否存在MCLS效应功能连接、结构连接和二者耦合性的异常，预期研究结果为揭示PD-ICD的神经机制提供理论依据，有望获得PD-ICD的客观影像学标志物。

冲动控制障碍（ICD）是帕金森病（PD）最严重的非运动症状之一，其发病机制不详，且缺乏客观的生物标记物。本研究使用基于体素-镜像同伦连接（VMHC）发现，伴有冲动控制障碍的PD患者存在额中回、额下回、尾状核、眶额回等涉及奖赏环路和抑制控制网络半球间功能连接失调，且额中回脑区VMHC值降低是PD-ICD的特征性改变，与冲动控制障碍严重程度显著相关，具有定量诊断价值。基于DTI影像图论分析发现ICD患者全脑拓扑结构连接过于优化，且左侧中扣带回、小脑的节点效率显著下降。格兰杰因果分析发现，由左侧扣带回至右侧额上回的效应连接降低，提示PD-ICD患者的皮层-边缘环路存在异常的效应功能连接。以上神经影像研究的结果初步揭示了PD-ICD的脑网络机制，为ICD的识别提供了客观的神经影像标志物，并为其神经调控治疗提供了潜在靶点。